Peachtree Park Pediatrics - Online File Upload

Next Steps:

2. Call the office to pay your annual $10/Child Administrative Forms Fee
3. Upload Your Form below or email it to
4. Please indicate in your email or in the comment section below if you would like us to mail the form back, upload to the portal, or if you would like to pick it up in the office. Three business days are required to complete form request.


Patient First Name*:
Patient Last Name*:
Patient Date of Birth*: (mm/dd/yyyy)
E-mail Address*:
Phone Number*: ( )
Comments or special requirements:
File to be uploaded*:
Maximum file size: 475 MB

Please hit "Submit" only once. The upload process made take several minutes depending on the size of the file and your internet connection speed. You will be shown a "File Upload Status" to monitor the progress of the upload.

Please do not browse to another Web Site. This will disrupt the file submital process.