3155 N. Point Pkwy, Ste D200, Alpharetta, Ga 30005

770-667-6967

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770-667-6967


  • Home
  • Patient Portal
  • Bill Pay
  • Meet the Doctors
  • Services
  • FORMS
  • CONTACT US
  • Blog

New Patient Forms

The forms can be emailed to us  at info@dchatpeds.com

*The medicaid form is only required for patients with Medicaid, Peachstate, Peachcare, Amerigroup, Wellcare, or Caresourse.

REGISTRATION FORM (pdf)Download
MEDICAL HISTORY (pdf)Download
MEDICAID FORM (pdf)Download
RECORDS REQUEST (pdf)Download

Sports

The sports history form can be completed and emailed to us at info@chatpeds.com

SPORTS HISTORY FORM (pdf)Download

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