English PATIENT FORMS

Patient Registration
Patient Registration
Medical History
Medical History
Medical Record Release Form
Medical Record Release Form
HIPAA & Consent
HIPAA & Consent
Acknowledgment Form
Acknowledgment Form

Spanish PATIENT FORMS

Patent Registration
Patent Registration
Medical History
Medical History
Medical Records Release
Medical Records Release
HIPAA & Consent
HIPAA & Consent
ACKNOWLEDGEMENT FORM
ACKNOWLEDGEMENT FORM

Hometown Pediatrics

22136 Medical Village Drive

Athens, AL 35613

For Life-Threatening Emergencies Call 911
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Please note that no one will be denied access to services due to inability to pay.
There is a discount/sliding fee schedule available. Please contact our office for more information.

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© 2020 by Hometown Pediatrics