FORMS

Send a copy of your child's immunization record and pertinent medical history via mail, email, or fax (205-638-9996). Including a copy of your insurance card could expedite your registration.

Mailing Address:
3300 Cahaba Road, Suite 102
Birmingham, AL 35223

Office: 205-870-7292
Fax: 205-638-9996

Fill out forms including:
Patient Information Form (PDF)
Medical History Form (PDF)
Release of Information Form (PDF)
Consent for Treatment of a Minor Child (PDF)
Foster Care Information Form (PDF)