115 Manning Drive SW, Suite A-101
Huntsville, AL 35801
Phone: 256-533-1030
Complete Our Patient Forms
Prenatal Form
At this current time we are no longer taking newborns.
We ask that current patients fill out the below form if they are adding a new baby to their family.
- Prenatal Information Form - for expectant parents
This information will be placed on file and used to create your child's chart once we are notified of their birth by you. We ask that you ensure that they send us your baby's discharge paperwork by providing them with the name of your pediatrician upon entering the hospital for delivery. You will be asked by the hospital to call our office and make your initial office visit prior to discharge from the hospital.
IMPORTANT: Please note that we practice scientific, evidence-based medicine where proof exists regarding the safety and efficacy of a medication or procedure. In keeping with this principle, we follow the immunization schedule recommended by the CDC and the Advisory Committee on Immunization Practices. If you are unwilling to vaccinate your children we recommend looking elsewhere.
Patient Forms
The below forms are for current patients.
- Family Demographic - only fill out if requested by office
- HIPAA Acknowledgement - for all newborn patients
- Newborn History Questionnaire - for all newborn patients
- Patient History Questionnaire - for all patients other than newborns
- Medical Records Release - This form is needed if you are wanting to transfer your child's records to another office, if you are wanting records released to yourself please enter your information in place of clinic information. In the state of Alabama if the child is over the age of 14, then they must sign these forms themselves - if they are being sent out of state please also have the parent sign as most states require parental signatures until the child is 18.
IMPORTANT: Please note that we practice scientific, evidence-based medicine where proof exists regarding the safety and efficacy of a medication or procedure. In keeping with this principle, we follow the immunization schedule recommended by the CDC and the Advisory Committee on Immunization Practices. If you are unwilling to vaccinate your children we recommend looking elsewhere.
Important Paperwork for all Patients to Review
- HIPAA Policy
- Recommended Schedule of Well Visits and Immunizations
- PCMH Brochure - We are a Patient Centered Medical Home, this brochure explains what that is.
About Us
With over 50 years of combined experience, Twickenham Pediatrics provides individualized patient care to the community of North Alabama.
Your child needs a pediatrician who cares for your health and well-being. So contact us today and schedule an appointment. We provide a FREE prenatal visit. At this current time we are no longer taking newborns.
All of our physicians are board certified by the American Board of Pediatrics and are Fellows of the American Academy of Pediatrics.
NCQA works with clinicians and practices to make sure they follow industry-leading best practices and guidelines, so patients get the best care at the right time. Practices that earn NCQA Recognition show they are committed to providing high-quality, patient-centered care.
Locate Us
Get DirectionsContact Us
