Online Patient Forms

Patient Form

Complete Our Patient Forms

Dr DeSimone is only accepting newborns with a referral.

Dr Dawson is not currently accepting any new patients.

Dr. Stringer is currently accepting new patients.

Prenatal Form

We ask that parents fill out the below form if they are adding a new baby to their family.



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 only to be filled out if requested by our office.


  • Newborn Patient Packet
  • Family Demographics
  • HIPAA Acknowledgement
  • 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



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