Patient Resources

Resources & Support

At Kennesaw Pediatrics, we are dedicated to providing you with comprehensive support throughout your child’s growth and development. This page provides patient resources. Our goal is to ensure you have easy access to all the resources you need for a smooth and informed healthcare experience.

Office Tours

We encourage expectant parents to visit our facilities, meet our staff, and learn about our services. Tours are available Tuesday through Thursday at 5:15 pm. Please call us at 770-429-1005 to register.

Patient Portal Information

At Kennesaw Pediatrics, we are dedicated to providing you with comprehensive support throughout your child’s growth and development. This page offers essential information on our classes and support groups, how to utilize the patient portal, access to necessary forms, and an overview of our office policies and procedures. Our goal is to ensure you have easy access to all the resources you need for a smooth and informed healthcare experience.

Launch the Patient Portal

Forms

For new and existing patients, all necessary forms, including registration, medical history, and consent forms, are easily accessible. Whether you’re preparing for your first visit or updating your child’s records, our forms are designed to be completed with ease.

There are three ways to submit forms:

Complete the forms through our secure, online system at this link.
Print the forms and fax them to us at 770-429-8005, drop them off, or mail them to 3745 Cherokee St, NW, Kennesaw GA 30144.
Arrive 30-45 minutes early to your appointment and complete the forms in the office.

New Patient Packet

Update Information For Existing Patients 

Medical Records Release

Authorization Of Treatment And Assignment Of Benefits  

Patient Authorization Signatures

Financial Policy

Advanced Beneficiary Notice

ADHD Information Packet

Hearing and Vision Records Request

TB And Lead Screening

Pre-Participation Physical Evaluation

Patient Satisfaction Survey

Referral Request

Immunization Records Request (3231)

Immunization Records Request (3231) — If this will be released to an outside organization, you’ll also need to complete the Medical Records Release FORM KP 2018. This form requires 48-72 hours for completion. This is a state form that certifies a child is up to date on immunizations, therefore your child must be fully up to date on all required immunizations for us to issue this form. If you child is not up to date, we can issue an Immunization List of all vaccines your child has received. You can also download this list from the portal at any time.

Form Fees

Immunization Records (3231) are provided at each well check, free of charge. Hearing and Vision Forms (3300) are also provided free of charge at any visit in which hearing and vision are checked. University System of Georgia Immunization forms are provided free of charge upon request at a well check. Sports or camp forms brought to the exam are also completed free of charge. Replacement 3231 or 3300 forms, or other forms that are dropped off for completion at a time other than an exam, are $10 per form.

Office Policies and Procedures

Cancellations and No-Shows

Our doctors, medical assistants and staff aim to make your visit a pleasurable one. In our efforts to make your visit more comfortable and to minimize your wait time, our office has implemented a late arrival policy. If a patient is more than 20 minutes late for an appointment, the appointment may need to be rescheduled. This is to ensure that the patients who arrive on time do not wait longer than necessary to see the provider. You may be given the option to wait for another appointment time on the same day if one is available. We will try to accommodate late‐comers as best as possible, but cannot compromise on the quality and timely care provided to our other patients.

Appointments who do not keep their scheduled appointment time or appointments not cancelled within 24 hours of their appointment time are subject to a $35.00 missed appointment fee.

Prescription Refills

Requests for prescription refills can be made 24/7 through our website or during office hours. Please allow 48 hours for processing. It’s essential to have a current medical evaluation for prescriptions, and monthly visits are required for ADD/ADHD medication refills.

Referrals

If your insurance requires a referral to see a specialist, please contact our office five business days prior to your appointment. You can request referrals through the patient portal or by calling our office.

Forms and Records

We provide essential forms like immunization records and hearing and vision forms at no charge during well-check visits. Other forms, such as those for sports or camps, are also completed free of charge if brought during an examination. There is a fee for forms requested outside of these visits.

Our team at Kennesaw Pediatrics is here to support you every step of the way. If you have any questions or need further assistance, please don’t hesitate to contact us. We are committed to providing the best care and resources for your family’s health needs.