To better assist you, Piedmont Pediatrics has a new Auto Pay Procedure as of October 1st.  
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Forms and Medical Records Request

Important forms needed to get you headed in the right direction

  • Forms are completed on a ‘first in/first out’ basis.
  • Please allow 5 business days for your request to be completed. We make every effort to complete these forms as quickly as possible. Due to the heavy volume of requests during back-to-school months, processing times may be longer. Please plan ahead!! 
  • Parents MUST complete all information on the forms that they have knowledge of (i.e. demographics, health history, etc.), and MUST sign and date their portion of the form.
  • Incomplete forms may delay the processing of your forms.

You may request your forms by way of:

  1. Completing the medical records forms request contact form by clicking here – Preferred method
  2. Fax: 404-793-0477
  3. Mail: 105 Collier Road NW, Suite 4060, Atlanta, GA 30309
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