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You may download and print any of our forms listed below before coming to our office. This will get you out of the waiting room and in to see the Doctor a lot quicker! You may either bring them with you to the first visit, or if you wish, fax them to us before your appointment.

To view the PDF files below, you may may need to download the free Adobe Acrobat® Reader®.


Patient Registration Form

Authorization for Release of Medical Records to Insurance Company

Authorization to Transfer Medical Records to Cartersville Pediatric Associates, PC
(Please specify Cartersville or Acworth Location on transfer form)

Notice of Privacy Practices

Patient Medical History

Financial Policy

Vaccines for Children Program

Confidentiality Notice

Insurance Company Listing
(If your Insurance company is not listed, please call the office for further information)