Forms & Policies

Appointment Information

Scheduling an Appointment at Intown Pediatrics

• We see patients by appointment only in an effort to keep your waiting times at a minimum.
• Our Patient Services team is dedicated to handling all incoming calls, requests and appointment scheduling. They can be reached during normal business hours by phone or message via the Patient Portal.
• Prior to scheduling, we will confirm your demographic and insurance information – so please have this information available when you call.
• We ask that you give as much detail as possible regarding the reason(s) for your appointment so that we can set aside the appropriate amount of time needed for your visit.

What to Bring to an Appointment

• Photo identification and a current insurance card (if applicable) are required to be presented at each visit.
• Payment for any co-payment, deductible, or balance remaining from a prior visit (if applicable). We accept cash, checks, Visa, Mastercard, and American Express.
• Minor children must be accompanied by a registered Parent or Guardian (at all in-person and telemedicine visits).
• As a courtesy, we will see unaccompanied 17-year-olds who are established patients with prior written authorization from the registered parent or guardian who have completed the General Parental Delegation Form of a Minor. This treatment authorization should be submitted as a message to us via the Patient Portal or text to (678) 249-3394 prior to the visit.
• We will see unaccompanied 16-year-olds who are established patients on a case-by-case basis, and these requests must be approved by the Physician or Nurse Practitioner prior to your appointment. This treatment authorization/ request should also be submitted as a message to us via the Patient Portal. Parents and guardians are encouraged to be reachable by telephone during these appointments in case any questions arise and are welcome to actively participate in any discussions via speakerphone.

Walk-Ins and Sibling Add-on Appointments

• We do not accept walk-ins and require that you schedule all appointments – whether it is a well visit, sick visit, or if you need to add sick siblings to an existing patient appointment.
• We reserve multiple “Same Day” sick visit appointments on our daily schedules specifically for these last-minute type visits. Calling ahead will ensure that one of these appointments is reserved for you and will allow our staff to prepare in advance for your arrival.

Missed Appointments and Late Cancellations

• We do not overbook our schedules, so when you schedule an appointment with our office that specific time has been set aside for you. Missed appointments and last-minute cancellations are very costly to our practice and also prevent us from giving that appointment to another child in need.
• We ask for 24-hours’ notice on all appointment cancellations when possible.
• A $40.00 fee (per patient) will be charged if you fail to show for an appointment or for avoidable cancellations that occur within 24 hours of the appointment time. Families with excessive no-shows or last-minute cancellations will be asked to leave our practice.

Late Appointment Arrivals

• We have a 10-minute grace period for late arrivals.
• If you are late for a scheduled appointment, we cannot guarantee that you will be seen. We will do our very best to accommodate you (if it’s possible to do so without inconveniencing other patients who arrived on time.)
• If we cannot accommodate you, we will reschedule your appointment for another day or time.
• Late arrivals are equal to a missed appointment; therefore a $40.00 (per patient) fee will apply.

Emergencies, Medical Advice, and After-Hours Calls

Emergencies

Call 911 in case of an emergency.
For the Georgia Poison Control 24-hour hotline, please call 1-800-222-1222

Medical Advice and Questions

• Our website is available 24/7 as a reliable resource for finding current, recommended pediatric medicine dosages or information on treating and managing hundreds of the most common pediatric illnesses and conditions. Visit Is Your Child Sick? from our home page for the most up-to-date treatment recommendations for your child’s specific symptoms.
• In the event you need additional assistance, our Patient Services department can be reached by phone or Patient Portal message during normal office hours. If calling during peak hours or seasons, you may be asked to leave a message, but our goal is to return all calls within 1 hour.  If you feel that your call is urgent or you have not been called back within a reasonable amount of time, please call again and let our staff know so that they can expedite your request.

After-Hours Calls and Assistance

• Calls received on holiday or outside of normal business hours will be forwarded to our after-hours automated attendant.
• For non-urgent calls such as routine questions, prescription refills or requests, medical records, referrals, or appointments, etc., please follow the prompts to leave a message for the appropriate department. Your call will be returned by our staff the following business day. Non-urgent requests may also be submitted via our Patient Portal.
• If your call is urgent and cannot wait until the following business day, from the automated attendant please choose option “1” to be transferred to our answering service. After hours medical advice calls will be routed to Children’s Healthcare of Atlanta’s Nurse Advice Line. If you need additional assistance our answering service will take your information and page the on-call doctor. In the event that we to refer you for emergency care or treatment outside of our normal business hours, we will recommend a Children’s Healthcare of Atlanta emergency facility.

Forms/Records Request

• Please bring all forms to be completed with you to your child’s wellness/routine or sick visit (such as procedure clearance forms), and we will be happy to complete them free of charge.
• Forms and Records Requests are completed in the order in which they are received. Please allow 5 business days for the completion of most forms and 10 business days for the completion of most records requests. Note that some medical forms and records requests are subject to a longer turnaround time. Parents should complete all the demographic and patient history information and sign and date wherever applicable. Forms and records requests cannot be completed if the information is incomplete or the child has not had the necessary checkup or tests required.

Annual Forms Fee

Forms & Processing Fee Policy – Effective January 1, 2026

• Starting January 1, 2026, an annual $25.00 form processing fee will apply for any forms for active patients who are not up to date on wellness or routine annual services, forms not associated with wellness or routine visits, patients without a portal account, or any form requested outside of a patient visit, or recently transferred to another pediatric practice.
• Form fees must be paid in advance. We will not accept or complete any form prior to receiving payment.
• Forms for vaccine records, long-distance calls, school excuses, F.M.L.A. forms, insurance applications, computer-generated account reports, completion of camp, school, and physical forms, etc. are all covered under the annual forms fee.
• The $25.00 annual forms fee will be assessed per family with fewer than three (3) children.
• A $50 annual forms fee will be assessed for families with four (4) or more children.
• Please note that we are unable to complete forms for inactive patients, including those who have aged out of the practice.
• Any other form not listed above may be completed at no charge during an office visit (well or sick) when the physical form is presented and given to the provider during the appointment.
• Please remember to bring a hard copy of the form you need completed to your scheduled visit.

School and Camp Forms

• Complimentary copies of the following standardized forms are provided on our patient portal for active patients that are up to date on well visits, preventative screenings, and immunizations: 3231 (GA Certificate of Immunization), 3300 (GA Hearing & Vision), and the standard Preparticipation Physical Evaluation/ Sports Clearance Form (the Patient History portion of this form must be on file from a prior visit to apply). Please log into the Patient Portal and check your “Forms and Documents” folder for current copies. If you do not see the form you need, submit a “Form Request” via the portal or email [email protected]. Our goal is to process portal standard form requests within 1 business day.
• Any other form (not listed above) will be completed at no-charge during an office visit (well or sick) when the actual form is presented and given to your provider for completion at the visit.

Sports Forms

Preparticipation Physical History & Evaluation: Click the link below 

Sports Physical Evaluation Form

Submitted Physical Forms must have ALL patient information fields completed by parents and include the following pages:

• History
• Athlete With Special Needs/Supplemental History
• Physical Examination
• Medical Eligibility

Forms submitted with missing pages cannot be completed.  You may email forms that have been completed to [email protected].

Please allow 3-5 business days from receipt.

Visit-Related Patient Forms

To view the forms listed below, you will need to download Adobe Reader.

Our office is going paperless! All visit-related patient forms can now be completed electronically and securely prior to your arrival at our office.

• Electronic Patient Information Forms are required for all new patients, at most well/check-up visit intervals, and at all ADD/ADHD related visits.
• You will receive a text and/or email a couple of days prior to your appointment requesting that you “check in”. You can minimize the time spent in our office by completing all assigned surveys and other tasks prior to your arrival.
• If you need assistance or choose not to complete these forms in advance, please plan to arrive 15 minutes earlier than your scheduled appointment time. 

Medical Records

• Active patients can log into the Patient Portal for immediate, complimentary access their medical records. From the “Patient Information” tab within the portal, click each category to view and/or print any records needed.
• If you are not an active patient, need records sent from us to a third party, or simply prefer that our staff print record copies for you, please download and complete a Medical Records Release Form.  Medical record copy fees will be charged for this method, and you should allow 10 business days for the processing of your request.

Paper Medical Records

• If you are transferring to another pediatric practice, we suggest requesting the last 2 well and sick visits, current immunizations, medication list and problem list to provide your new pediatrician with the information they need for continuity of care. There is no charge for these limited records to be sent to them once a Medical Records Release Form has been completed.
• If you, the parent/guardian, would like your child’s complete medical record in paper form, there is a $35.00 fee, and we are happy to send this to you via email or by standard mail.

Incoming Medical Records

• Records being sent to us can be emailed to [email protected] or faxed to (404) 446-4727. Click the link above for the required records release form.

Outgoing Medical Records

• If you need medical records sent to another practice, please complete the records release form (linked above) and email it to [email protected]. Please allow 5-10 business days for processing.

HIPAA Policies

• Please click on the link to read our HIPPA Policies.

Payment Policies

• Payment is due at the time of service, and co-pays and deductibles are collected in advance of your appointment. Any prior balances must be paid before receiving any additional services. Please click on the link to read our Financial and Administrative Policies.

ADD/ADHD Treatment Forms

• Please click here for the  ADHD Teacher Form and the ADHD Parent Form.

Other Forms (Katie Beckett, FMLA, etc.)

• These forms should be emailed to [email protected] and will be processed within 5-10 business days.
• For questions or status updates regarding any medical records or forms, please text us at  (678) 249-3394, and we will respond within one business day.

Accessing Forms and Your Child’s Medical Record

• Please Note: The easiest way to access your form, once completed, is through the Patient Portal or the Healow app. We encourage you to use the patient portal.