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Martinez: (706) 863-1440South Augusta: (706) 792-5040

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  • Home
  • Patient Care
    • Pediatric Care
    • After Hours Care
    • Patient Forms
  • About Us
    • Vision & Mission
    • Meet the Providers
    • Meet the Staff
    • Careers
  • Learning Center
    • FAQ
    • News
    • Pediatric Care Blog
    • Suggested Links
  • Contact Us
    • Schedule Appointment
    • Contact & Directions
    • Pay Online
    • Terms of Use

New & Existing Patient Forms

New Patient Forms

  • Medical Information Release Form (fax or mail back to us at least 2 wks prior to your first visit).

  • Notice of Privacy Practices and Indvidual Rights – Summary

  • Privacy Practice and Individual Rights Acknowledgements

  • Vaccine Policy

  • Vaccine Cost Coverage

  • Financial Policy

  • Patient Registration

Other Patient Forms

  • Sports Physical Form

  • ADHD Assessment Form (parent)

  • ADHD Assessment Form (teacher)

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Martinez Office:

Phone:
(706) 863-1440
Fax:
(706) 863-5418
Email:
covpeds.recptmart@knology.net
Address:
4106 Columbia Rd. #103
Martinez, GA 30907

South Augusta Office:

Phone:
(706) 792-5040
Fax:
(706) 792-5045
Email:
covpeds.recptpo@knology.net
Address:
3121 Peach Orchard Rd, #102
Augusta, GA 30906

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