Patient Forms

Please print the following forms and complete prior to your visit with East Cobb Pediatrics. These must be done prior to your visit or you may experience a delay or need to be rescheduled. Please be sure to print the forms that correspond with the location you will be visiting

Picture of Medical paperwork

MARIETTA – NEW Patient Administrative Forms   (Please only complete 1 Registration form per family)

MARIETTA Established  Patient Administrative Forms – Updated yearly

KENNESAW  NEW Patient Administrative Forms (Please only complete 1 Registration form per family)

KENNESAW Established  Patient Administrative Forms – Updated yearly

Financial Policy 

Self Pay Policy

Self Pay Price List

Financial Information – I Was Charged for That?

Authorization and Consent for Medical Treatment of a Minor Child

18 YR Authorization Form

Medical Record Release Forms

ADHD Forms

ADHD Packet – To be completed prior to scheduling Parent Consultation

ADHD Follow up Packet – to be completed prior to Med Check visits

Auto Refill Information

Additional paperwork –   If you do not see your child’s age below there is no additional paperwork to be completed. Thank you!

2 months

6 months

9 months

12 months

18 months

2 yrs

30 Month

3 yrs


7 yrs

11 yrs

14 yrs



Office Hours

Marietta Office:

Mon - Fri 8:30 am to 5:00 pm (For your convenience our doors are open at 8am and close at 5:30pm in order for you to sign in for walk-ins or pick up prescriptions or paperwork)

Saturdays (Oct-Mar) Walk-In 8:30am to 10:30am
For sick established patients only (Marietta Office ONLY)

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Kennesaw Office:

Mon - Fri 8:30 am to 5:00 pm

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Both Offices are closed for lunch - 1:00 to 2:00 daily


Walk-ins are available to established patients with acute illnesses at both offices 8:15 am to 9:30 am Monday through Friday.

Need After Hours Care? We recommend:
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Sign up for the East Cobb Pediatrics Patient Portal CLICK HERE
Please Complete Registration Paperwork Prior To Your Child's Visit