New patients 

New patients will need to complete these forms prior to their initial appointment: 

• Patient Registration Forms / Initial History Questionaire [PDF] [Online]
• New Patient Request Form [PDF] [Online]
• Prenatal Patient Request Form [PDF] [Online]

 

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All patients 

All established patients will need to complete these forms once a year or with any information changes:  

• Patient Registration Forms [PDF] [Online]

 

All patients will need to complete this form at each visit. 

• Non-Covered Services Statement

 

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Transferring patients 

If you are tranferring your child's care TO Alabaster Pediatrics FROM another provider, please complete this Medical Records Request. 

If you are transferring your child's care FROM Alabaster Pediatrics TO  another provider, please complete this Medical Records Release [PDF] [Online]

 

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ADHD Evaluation Forms

Patients undergoing initial ADHD evaluations will need to have 1-2 parents and up to 3-4 teachers complete these initial forms.

• Initial Evaluation - Parent [PDF] [Online]
• Initial Evaluation - Teacher [PDF] [Online]

Patients having follow-up ADHD evaluations will need to have 1-2 parents and up to 3-4 teachers complete these follow-up forms.

• Follow-up Evaluation - Parent [PDF] [Online]
• Follow-up Evaluation - Teacher [PDF] [Online]

 

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Autism Screening

• M-CHAT screening

 

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In order to view or print these forms you will need Adobe Acrobat Reader installed.

Click here to download it.

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The forms above can be returned to our office by: 

• Email: [email protected] 
• Fax:  205-663-1990  
• Postal Service/Hand deliver:  1004 1st Street North,  Suite 370,  Alabaster, AL  35007

Alabaster Pediatrics
1004 1st Street N
Suite 370
Alabaster, AL 35007
(205) 663-5547
(205) 663-1990 fax

View map and directions

Please contact our office by PHONE with questions or for more information! 

Emails are not being received at this time.