Cobb Pediatric Associates, PC
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Forms

If you are a new patient at Cobb Pediatric Associates, please fill out our New Patient Forms Packet below. The packet includes: Permission to Send PHI by Unencrypted Email, Patient Registration, Medical History, Patient Agreement for Communication, Authorization to Treat Minor, and Financial Policy.

New Patient Forms Packet

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Additional Forms

  • Patient Registration
  • Permission to Send Patient Health Information (PHI) by Unencrypted Email
  • New Electronic Medical Record Announcement to Patients
  • Medical History​
  • ​Well Visits and Additional Charges
  • Policy for Sick Visit During Checkup Visit
  • Patient Agreement for Communication
  • ​Authorization to Treat Minor
  • Authorization to Release Records TO Cobb Pediatric Associates
  • Financial Policy
  • Parents of Newborns
  • Authorization for Cobb Pediatric Associates to Release Records TO ANOTHER Provider Office​
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