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Admin Desk

New Patient Login
Mother and Child

Newborns

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If you are an expectant parent and would like to become a new patient at our office, please follow one of the steps below:

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  • Delivering at South Georgia Medical Center: The hospital nursery will provide you with our Newborn Packet.

  • Delivering at another facility: You are welcome to print the Newborn Packet from our website.​

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Please bring the completed Newborn Packet with you to your child’s first appointment.

New Patients

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If you are new to the area or wish to transfer your child to our office, please complete our New Patient Acceptance Form.

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You have two options for submitting the form:

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  • Print and Deliver: You may print the form and hand-deliver it to our front desk staff at the Main Clinic, located at 406 M. Northside Drive, Valdosta, GA 31601

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  • Complete In Person: If you are unable to print the form, you are welcome to complete it in person at the same location.​

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Once your application has been reviewed, one of our front desk staff members will contact you with further instructions.

Current Patient Forms

Already a patient? Select a form below

English

Infancy

3-5 Day Well Visit

Early Childhood
Middle Childhood
Adolescence

1 Month Well Visit

Early Childhood
Middle Childhood
Adolescence

2 Month Well Visit

Early Childhood
Middle Childhood
Adolescence

4 Month Well Visit

Early Childhood
Middle Childhood
Adolescence

6 Month Well Visit

Early Childhood
Middle Childhood
Adolescence

9 Month Well Visit

Early Childhood
Middle Childhood
Adolescence
Early Childhood

12 Month Well Visit

15 Month Well Visit

18 Month Well Visit

2 Year Well Visit

2.5 Year Well Visit

3 Year Well Visit

4 Year Well Visit

Middle Childhood

5 Year Well Visit

6 Year Well Visit

7 Year Well Visit

8 Year Well Visit

9 Year Well Visit

10 Year Well Visit

Adolescence

11-14 Year Well Visit

15-17 Year Well Visit

18-21 Year Well Visit

Additional Forms

Parent & Teacher Initial ADHD (Vanderbilt) Forms

Parent & Teacher Follow-up ADHD (Vanderbilt) Forms

In-Office ADHD Follow-up Parent Eval

SCARED anxiety screen for Parents to complete

SCARED anxiety screen for Child to complete

OCI-R (Obsessive Compulsive Inventory)

Respiratory Clinic Form

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Headache Diary

Behavioral Management

BMI Management Form

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My Daily Food & Drink Diary

Sports Pre-Participation

Concussion Checklist

Español

Infancia

2-5 días de visita de bienestar

1 mes de visita de bienestar

2 meses de visita de bienestar

4 meses de visita de bienestar

6 meses de visita de bienestar

9 meses de visita de bienestar

Niñez temprana
La mitad de la infancia

12 meses de visita de bienestar

15 meses de visita de bienestar

18 meses de visita de bienestar

Visita de bienestar de 2 años

Visita de bienestar de 2.5 años

Visita de bienestar de 3 años

Visita de bienestar de 4 años

Visita de bienestar de 5 años

Visita de bienestar de 6 años

Visita de bienestar de 7 años

Visita de bienestar de 8 años

Visita de bienestar de 9 años

Visita de bienestar de 10 años

Adolescencia

Visita de bienestar de 11-14 años

Visita de bienestar de 15-17 años

Visita de bienestar de 18-21 años

Formas Adicionales

Clínica respiratoria

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