Please click on the links below, print out and complete the BOTH the Registration forms AND the New Patient Medical History/Immunization Forms below. Additionally, please bring the following items to your first appointment:
New Patient Registration Forms (Registration + Financial Policy + Medical Practice Annual Acknowledgement)
New Patient Medical History/Immunization Forms
If any of the following applies to you, we request that you please download and complete the Registration Forms below and bring them with you to your next appointment:
Patient Registration Forms (Registration + Financial Policy + Medical Practice Annual Acknowledgement)
If you would like a copy of your medical records, please complete the form below or fax it to us at Holly Springs Office: Fax (678) 388-5489 or Towne Lake Office Fax (770) 852-7721.
Please allow two weeks for this request to be completed.
Medical Records Release
Patient Rights & Responsibilities
HIPAA Notice of Privacy Practices
Partnership for Safety Information Guide
We accept most major health insurance plans, however it is your responsibility to contact your insurance carrier to verify coverage and benefits. Patients may be held financially responsible for payment of services should the insurance company deny responsibility. Be sure to bring your insurance card with you every time you visit Northside Cherokee Pediatrics. Notify the front desk whenever your insurance coverage changes so that the medical staff can accurately maintain your important medical records.
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Click here to download it.