The following forms are available for your convenience. Please fill out any needed forms prior to your appointment. By doing so, your paperwork can be more accurately completed and will speed up appointment check-ins.

Avaliable Forms Medical Record Release Consent for Medical Treatment Patient Infromation Patient History Questionnaire Medical Photography Release/Approval Patient HIPPA Acknowledgement Appointment Cancellation Policy Billing Policy Privacy Notification Consent for Medical Decisions Consent for Treatment for Emergency Care ADHD (Parent) ADHD (Teacher) Sports Physical

For patients requiring Shot forms (680) or yellow physical forms (3040), they are available upon request in our office.

**NOTICE: There will be a $2.50 charge for each yellow physical form (3040).

A staff member of Pediatric Associates of Julington Creek
preforming a routine Strep test.