We would like to welcome new patients to the office of Pediatric Associates of Alexander City, P.C.
We understand your time is valuable and would like the registration process to go as smoothly as possible.
1. Take the steps below to begin the registration process. All new patients will complete the New Patient Electronic Registration. Transfer patients from another provider will also fill in/print the Medical Record Request. If you are covered under Medicaid, and your are transferring from another provider, then you will need to fill in/print the Alabama Medicaid Agency's Recipient Change Report Form. If you are on Medicaid and recently given birth, then you will fill in/print the Patient 1st Newborn Form. If you are unable to print these forms they can be picked up from either location.
2. A Patient Representative will contact the parent or legal guardian within 48 hours of receiving the form for further instructions and information. Please make sure to provide accurate contact information.
3. If you are transferring from another provider, then return the Medical Record Request to either of our locations. If you have the form signed prior to bringing to the office, then you will need to have notarized. If you wait to sign the form in the office, then we will witness the signature for you.
4. PLEASE NOTE: Providers recognize a general courtesy to return medical records within 30 days. Under most circumstances we will not see the patient until we receive these records. You can possibly assist in the timely delivery of these records by contacting your current provider and making them aware of your change in primary care provider to Pediatric Associates of Alexander City, PC, especially if the patient has chronic or behavior diagnosis that would need prompt attention.
5. Once we receive the medical records we will contact you to schedule your initial appointment. Please bring your medical insurance cards and a valid photo ID of the legal guardian. We request you arrive at least 15 minutes prior to your scheduled appointment. A parent or legal guardian will need to accompany the child to the appointment.
6. We have an electronic registration process for office visits. A couple of days prior to your first appointment you will receive a text message with a link to complete this registration which will include one or more of the following: verifying the demographic and insurance information we have already collected, medical history, known allergies, patient consent forms, and our covenant of care.
Thank you for choosing Pediatric Associates. If you have any questions about this New Patient Registration please call 256-234-5021 and press option 2.
If you are interested in becoming a patient of Pediatric Associates of Alexander, P.C. take the following steps:
1. Click the link below to fill out the New Patient Electronic Registration. You can complete one registration for multiple siblings provided they have the same legal guardians, financial responsibility, and live in the same household. For each child that has a different legal guardian or different household you will need to fill out a new form for each one. If you need to stop and return to the form at a later time there are opportunities to save your progress. Make sure to return to this page and complete all forms. Once we receive your forms we will contact you within 48 hours for any further information.
If you are unable to complete the New Patient Electronic Registration, then you may download and print the following New Patient Form to complete and bring in to either office. Print one form for each child you are registering. DO NOT SIGN. YOU WILL SIGN IN THE OFFICE.
2. Click the link below to download the Request for Medical Records form. Please fill this form out completely and bring back to either of our locations. DO NOT SIGN. YOU WILL SIGN IN THE OFFICE. Please note once we send the Request for Medical Records to your current provider they have up to 30 days to return those records. In most cases we are unable to schedule an appointment until we receive those records. It helps for you to contact all of your current providers to let them know you are transferring out to Pediatric Associates of Alexander City, PC.
3. If you are covered by Medicaid please download the Alabama Medicaid Agency's Recipient Change Report Form. This is a form required by Medicaid when you change your primary care provider. Please fill this form out completely and bring back to either of our locations with your Medical Record Request. DO NOT SIGN. YOU WILL SIGN IN THE OFFICE.
4. If you are covered by Medicaid and need to assign your newborn to a provider please download the Alabama Medicaid Agency Patient 1st Newborn Assignment Form. This is a form required by Medicaid to have your newborn assigned to a provider. Please fill this form out completely and bring back to either of our locations with your Medical Record Request. DO NOT SIGN. YOU WILL SIGN IN THE OFFICE.