Complete Office Forms Online
Save time by completing any necessary forms at your convenience, before your visit. All form submissions are HIPAA-compliant through our secure server.
NEW PATIENT FORMS
Please complete this list of new patient forms at your convenience. This includes a records release and a credit card authorization form. We require a credit card on file for all patients.
Once we have received the completed forms, we will request your child’s records from their previous provider. Please note that by law, offices have up to 30 days to send medical records.
As soon as we receive those records and create a chart, we will contact you to let you know we can begin scheduling appointments. If you have any questions, please do not hesitate to call our office at (251) 928-5568.
New Patient Forms
- Please complete the forms below In preparation for your first visit. You will automatically be taken to the next form in the list.
- Patient Demographics
- Health History
- Consent to Treat
- Office Policies
- Vaccine Policy
- Privacy Practices
- Release Medical Records to Fairhope Pediatrics
- Medical/Financial Disclosure
- Credit Card Authorization
Release and Consent Forms
- Use these forms to permit the sharing of medical or financial information, or to change the address you have on file.
- Minor Disclosure
- Release Medical Records to Fairhope Pediatrics
- Release Medical Records from Fairhope Pediatrics
- Change of Address
- Parent Flu Consent
Financial Forms
- Forms related to finances or bill payment.
- Credit Card Authorization
Telemedicine Forms
- Please complete the forms below In preparation for your first telemedicine visit. You will automatically be taken to the next form in the list.
- Telemedicine Consent Form
- Credit Card Authorization
School Forms
- Forms published by Baldwin County Public Schools, and others.
- AHSAA Pre-Participation Sports Physical Form
- Activity ToleranceEn Español
- Diet Prescription Form
- Medication Authorization
- Sunscreen/Bug Spray/Diaper CreamGrant permission to a school or daycare to apply sunscreen, bug spray, and/or diaper rash cream for your child.
- Health Services DocumentsAdditional documents and forms