The Pediatric Place

Please complete the Contact and Consent form if you have not already done so or if your information has changed.
Patient Consent Form for 18 years and older

Complete the Adolescent Form:
Adolescent Health Questionnaire for 13 years and older

If you are completing online, use a computer (not cell phone).  You can email to:   or fax to: 770-988-5553.  Or, you can print and bring with you.