The following forms are provided to help make your visit to Partners in Pediatrics as convenient as possible. On this page, you'll find information about our general office policies as well as links to some of the forms that you can print and fill out before your appointment.
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Our Policies:
- Welcome to Partners in Pediatrics
- Billing & Insurance
- Financial Policy
- General Office Policies
- Immunization Policy
Medical Records
- Medical Record Release Form (For transfers out of our office or requesting records)
- You may also access your medical records on our patient portal.
Medical Forms, Letters, and Immunization Record Request
Effective January 1, 2025, Partners in Pediatrics implemented the following form fee policy regarding the completion of medical and school/daycare forms, letters and immunization records due at the time of request:
- Standard Form Requests: A $10 fee will be applied for completing forms or immunization records not requested during a medical visit. Please allow 5–7 business days for processing most forms.
- Rush Requests: If you require forms to be completed within 1–2 business days, a $25 rush fee will be charged.
- FMLA Forms: Completion of new Family and Medical Leave Act (FMLA) forms will necessitate an in-office visit.
Standard Form Request include: | |
|---|---|
| Sports & Physical Participation Documentation | Disability-related letters |
| Headstart/Daycare forms | Diagnosis Verification letters |
| Academic or Childcare letters | IEP/504 Letters |
| Medical Necessity & Coordination Letters | Legal letters |
| Renewal of FMLA forms already completed for same diagnosis | Other non-standard letters as determined by your medical provider. |
*WIC Prescriptions and Medication Authorization form are FREE*
Insurance companies do not provide a benefit for completing medical forms, so we require payment when the service is requested.
See our full forms policy here.
How to request a form:
- Fill out our formal request form either in office or online.
- Drop off the form at your nearest Partners in Pediatrics office.
- Make sure all parent portions are completed at drop off to prevent delays.
- Call and leave a message on our nurse line (For immunization records, letters, WIC Rx, and Med Authorizations).
- Upload the form and the request to our patient portal and send a message with your best contact info and the date needed.
New Patient Forms:
For all new patient questions or concerns or to confirm that we are accepting your insurance plan, please call our office at 334-272-1799.
We can guide you on selecting an available doctor, how to have your records transferred and what information we will need to schedule your first appointment. Appointments are scheduled after we have received your medical and immunization records.
- Request for New Patient Appointment - This form adds you to our waitlist. Please be patient as we process new patient requests.
- New Patient Registration Packet (To be completed prior to new patient appointment after you have been accepted to our office.)
- HIPAA Notice of Privacy Practices (Review only)
Additional Patient Forms:
- Patient Update Form (For established patients only - to be completed every 12 months or with any changes to information)
- Patient Portal Instructions
- Asthma Questionnaire
- Nine Month Questionnaire
- 24 Month Questionnaire