Home » Patient Information » Patient Forms & Fees

Patient Forms & Fees

The following forms are available in English and in Spanish for your convenience. Please complete the forms and bring with you to your visit. If you have any questions about any of the information required, call our office at 404-255-2033 for assistance.

En Español

Descargue y complete las siguientes nuevas formas pacientes antes para su primera visita. Favor de trerlas con usted. Esperamos verte! No olvide leer el aviso de prácticas de privacidad disponible para su descarga desde la izquierda de esta página.

 

Fees

Pediatric Ear, Nose & Throat of Atlanta has instituted an administrative fee for the production of medical forms and paperwork that are not covered by insurance and are time-consuming for the staff to process.

This administrative fee covers hearing/vision form required for daycare centers and schools, F.M.L.A. paperwork and copies of a patient’s medical record. Fee payments will be collected prior to fulfillment of any requests.

Hearing & Vision (3300) Form —$15

*Free if requested at the time of visit while in office

Family Medical Leave Act Packet—$35

*Please allow 7-10 business days to complete

Medical Records copies—$25 search & retrieval fee + per sheet fee

*Please allow up to 30 days from the date requested to fully process