To better assist you, Piedmont Pediatrics has a new Auto Pay Procedure as of October 1st.  
(All Announcements)

"Our children are going off to camp! How do we get our forms to our physician?"

Form requests are now handled exclusively in our new patient portal My Kids Chart powered by PCC. You are able to upload a picture or PDF file of the form that you need completed, and can have the form released directly back into your patient portal for convenient retrieval!


  • Forms are completed on a ‘first in/first out’ basis. If you have an upcoming wellness exam, please bring your forms to the appointment so that your physician may complete them same-day.
  • Form requests MUST be submitted via the patient portal or in-person. Email and phone/voicemail submissions will not be accepted due to the high volume of requests.
  • Any physical examination forms (including but not limited to: GHSA sports packets, Georgia Form #3300, School Examination forms, etc.) cannot be processed if the patient has not had a wellness exam within the last twelve (12) months from the date of form submission.
  • Patients over the age of eighteen (18) years of age will need to submit their own requests or submit a parental authorization form to further allow parental access to medical records on behalf of the patient, including access to the patient’s chart in the patient portal. Without prior parental authorization, access to these patient’s records will be denied.
  • Form request turnaround time is seven to ten business days from the date of submission. We make every effort to complete forms as quickly as possible, but the heavy volume of requests may cause delays– so plan ahead! The quicker your submit your request, the quicker we can get it back to you!
  • Parents MUST complete all information on the forms that they have knowledge of (i.e. patient demographics & signatures , health history, allergies, medications etc.) Blank forms will  NOT  be accepted for physician review, and forms missing any of these fields may cause delay in the request.



Submitting a form request in the portal (USING THE ‘CREATE MESSAGE‘ BUTTON):




You may request for records to be release to/from Piedmont Pediatrics utilizing our release forms below.

If you are leaving the practice, need records for personal use, or are continuing care with a specialist, please utilize the Release of Records FROM Piedmont Pediatrics form.

If you would like Piedmont Pediatrics to request records on the patient’s behalf, please utilize the Release of Records TO Piedmont Pediatrics form.

After completing your records release form, you may submit it via the My Kid’s Chart portal.

You can access the patient portal here:   

If you have not registered and need access to “My Kid’s Chart” patient portal, click on the button below to request access. Piedmont Pediatrics must enable access manually from our end, so please allow at least 24 hours to receive your portal activation confirmation.


For your convenience, we have provided various forms below that you may download, complete your portion, and re-upload into the portal for physician review. Please do not submit blank forms for physician review or your request will be denied and returned. If you have your own forms needing to be uploaded, you have the opportunity to do so in the Forms Request function of the patient portal. Please see these forms below

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