Home Our Story
Meet The Providers PMG Press Coverage
Request Appointment

Patient Forms

New Patient Registration — Family Practice, Pediatric & Newborn

Questions? Call Ciera: (334) 664-0463 ext. 3320
Response within 3 business days

Complete Your Registration

Thank you for your interest in becoming a new patient with Preferred Medical Group. All forms are required to complete your new patient registration. Please fill out every required section.

If you are unsure of an answer, please do not leave it blank — write "N/A" instead. Once your packet has been fully completed and submitted, our new patient coordinator will contact you within 3 business days.

If you need an immediate appointment or have questions about the registration process, please contact our new patient coordinator, Ciera, at (334) 664-0463 ext. 3320.

Our Family Practice New Patient Registration Packet includes all 5 forms below. Your registration cannot be processed until all 5 forms have been fully completed and submitted.

1

FP Registration

Required
2

Family Practice Medical History

Required
3

HIPAA Authorization

Required
4

Request for Medical Records

Required
5

Office Policies

Required

Our Pediatric New Patient Registration Packet includes all 5 forms below. Your registration cannot be processed until all 5 forms have been fully completed and submitted.

1

Pediatric New Patient Registration

Required
2

Pediatric Initial History Questionnaire

Required
3

Allowed to Bring Child / Specialists

Required
4

Request for Medical Records

Required
5

Office Policies

Required

Our Newborn New Patient Registration Packet includes all 5 forms below. Your registration cannot be processed until all 5 forms have been fully completed and submitted.

1

Pediatric New Patient Registration

Required
2

Newborn Questionnaire

Required
3

Allowed to Bring Child / Specialists

Required
4

Request for Medical Records

Required
5

Office Policies

Required

Questions About Registration?

Contact our new patient coordinator Ciera at (334) 664-0463 ext. 3320, or email us at registration@preferredmedgroup.com. We look forward to welcoming you to Preferred Medical Group.

Dr. Ritu Chandra

Welcome from the Founder

Dr. Ritu Chandra, MD, FAAP

Welcome! I'm Dr. Chandra, a pediatrician and the founder of Preferred Medical Group. My family and I are proud to call Alabama home, and I've had the privilege of caring for this community since 2007.

As a pediatrician, I've always been passionate about providing the best care for children, but I recognized the need for both primary care and mental health services, which is why I've made it a priority to offer these services alongside pediatric care in my practice. It's important to me that every family has access to comprehensive care in one place, and I'm grateful for the opportunity to support the health and well-being of our community.

It's truly an honor to be trusted with your family's health, and I'm grateful to serve this community with the love and care that it deserves. Thank you for allowing me to be part of your lives — I look forward to supporting you and your family for many years to come.