New Patient Forms

We are so excited that you are choosing us as your medical home. We are currently accepting new pediatric patients at Phenix City Children’s and patients of all ages at Fort Mitchell Clinic. To become a new patient, we ask that you download and fill out EACH of the new patient forms, found below (pediatric for children 18 and younger and family medicine for anyone over the age of 18.) After you have read through and filled out these fors, please drop them by either of our office locations. Then, after a period of 1-2 business days, our staff will contact you. Thank you!

Pediatric Registration Form – Fill Out Online

Pediatric Registration Form – PDF Format

Family Medicine Registration Form – Fill Out Online

Family Medicine Registration Form – PDF Format

Child Psychology Intake Form

Office Policies Acknowledgement Form

Records Request



New Patient