Forms – Minor/Child

Online Forms – Please click on the links below to submit these 2 forms. You may have to upload or submit additional information separately:

New Minor Child Multi-Part Quick Form

Appointment Policy

If you are unable to upload a copy of insurance card while completing the form, please submit any of the following forms and documents as needed in one of the following methods:

  1. Email
  2. Secure Fax 877-660-8884
  3. Text (if you are prefer this method) 470-420-9994

Following Are Examples of Forms & Documents You May Be Asked To Provide:

ID for Parent

ID for Child (Birth Certificate; School Transcript or Report Card; Medical/Dental Record)

Insurance Card (s) – Primary and Secondary if applicable

Parenting Plan portion of Court Order for Custody – if applicable

School Records (if applicable) i.e. Section 504 Plan; IEP; FBA/BIP; Educational Evaluation; Report Card

Psychological Reports or Evaluations (if applicable)

Medical, Developmental, Pediatric Records, Reports (if applicable)

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