Johns Creek Pediatrics Patient Forms
Patient Registration Forms
Please download and complete the following medical record release form and submit to our office by mail, fax or e-mail to [email protected]
- New Patient Form [PDF]
- Authorization for Release of Medical Records To Johns Creek Pediatrics [PDF]
- Request for Release of Medical Records From Johns Creek Pediatrics. [PDF]
- 18 Year old Consent Form [PDF] [Online]
- Consent to Treat Authorization [PDF] [Online]
Adolescent Well Check Questionnaires
- Younger Adolescent Questionnaire 12-13 Yrs. [PDF]
- Middle-Older Adolescent Questionnaire 14-21 Yrs. [PDF]
Evaluation of Attention Deficit Disorder
If your child is being evaluated for the possibility of a new diagnosis of attention deficit disorder or you may download and complete the paper forms below.
Complete these forms if your child is being seen for a follow up visit for attention deficit disorder:
- Vanderbilt Parent Assessment Follow-up Form [PDF]
- Vanderbilt Teacher Assessment Follow-up Form [PDF]
- Vanderbilt (Adult -Over age 14) Follow-up Form [PDF]
Section 504 Plan
School, Medication & Sports Forms
Please complete this form and email or fax it to us if you would like for us to send your child's completed immunization record, sports form, medication authorization or school absence verification to you or another party. Your signature allows us to release this private health information as you designate.
Immunization (3231) and Hearing/Vision/Dental Certifications (3300)
We are happy to provide you with forms for daycare and school. You can request these forms on-line below or call our office for a specific form. NEW PATIENTS: We can complete the forms that are required for your child to attend Georgia public schools and update your immunizations to meet state requirements. Please schedule a new patient appointment. If possible, please provide medical and immunization records to us a few days prior to your visit.
Sports Physical/Camp Forms
- Preparticipation Physical Evaluation Form [PDF]
We will complete these forms for you if your child has had a well child visit within the past 12 months. Please drop these forms off with parent/child section already completed by you the parent. If your child needs a well visit, please schedule an appointment. Forms can be completed at that time.