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Pediatrics R US
Pediatrics-R-US
Pediatrics R USPediatrics R US

  nurse@pediatricsrus.com

(478) 452-3835

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  • Home
  • Appointments
  • Health Check
  • Immunizations
  • Nutrition
  • About US
  • Contact US
  • FeedBack
  • Financial Policy
  • Links
  • Blog
  • COVID-19
  • Services

Other Forms

Other Office Forms

Please select the appropriate form from the list below
PRUS - EP
  • Consent for TeleMdicine video call

  • Confirm (Cancel or Reschedule) your appointment

  • ADHD/ADD evaluation form.

  • Depression Screen

  • Anxiety Screen form.

  • ​Request refill on medications.

  • ​Upload files or documents.

  • Immunizations consent form.

  • Immunization refusal form.

  • Blood pressure journal entry.

  • Authorization to release medical records.

  • Authorization to obtain medical records from another entity.

  • Change of name (address or phone number) form.

  • Authorization for non-Parent (non-Guardian) to accompany Patient.

  • Medical treatment authorization for a minor​.

  • Sport physical form.

  • Head start physical form.

  • Form 3300 (Certificate of Vision, Hearing, dental and nutrition screen).

Please click on the appropriate form listed above, enter your child’s name and your Email address then fill out the form and click submit, we will review the submitted form on same working day.

Links:
  • Home
  • Request an appointment
  • Confirm an appointment
  • Cancel an appointment
  • Upload document
  • Patient's intake form
  • ADHD Evaluation form
  • Pay a bill
  • Medication Refill
  • Change name(address/phone number)
  • Authorization to obtain medical record
  • Authorization to release medical records
  • Blood pressure journal entry
Contact Information:
  • Phone / Fax numbers:
    Phone: (478) 452-3835
    Fax: (478) 295-3050
  • Email:
    nurse@pediatricsrus.com
  • Address (Pediatrics R US):
    1015 Fernwood Drive, Milledgeville, GA 31061 (directions)
  • Address (Eatonton Pediatrics)
    116 Sparta Hwy, Eatonton, GA 31024 (directions)

Find us on:

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Office Hours:
  • Pediatrics R US
    Monday & Wednesday: 8:00 am - 4:00 pm
  • Eatonton Pediatrics
    Tuesday & Thursday: 8:00 am - 4:00 pm
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