Interactive medical records release form

Thank you for selecting GI Care for Kids in the Greater Atlanta area for your child’s gastroenterology care. To schedule an appointment, please call us at (404) 257-0799 or use our secure online appointment request form.

Completing this form prior to your visit will help speed up the new patient registration process. You may also print the downloadable pdf forms, fill them out, and bring them with you to your first visit.

Doctor, Hospital, Provider etc. contact info:
I understand that:
- My right to healthcare treatment is not conditioned on this authorization
- if the person or facility receiving this information is not a healthcare or medical insurance provider covered by the privacy regulation, the information stated above can be disclosed
- There will be a charge for the requested records, Doctors' offices will not be charged for requested records.
- Please allow 7-10 business days of this request for records to be available for pick-up or delivery