Kilby Pediatrics

Caring About the Little Things

Patient Forms

• Patient Registration Form
  
• Notice of Privacy Practices
  
• Acknowledgment of Privacy Practices
  
• Release of Medical Records
  
• Authorization for Release of Health Information
  
• Notice of Policies and Procedures

Additional Forms

• Virginia School Entrance Health Forms
• VHSL Sports Participation Forms
  
• Boy Scouts of America Health Forms
• Madison County Schools - Medication Dispensing Consent Form 

Registration forms for all new patients will need to be completed before your child is seen by the doctor.  Additionally, all patients are required to update these forms on a yearly basis.  It will save you time, if you fill out the registration forms to the best of your ability and bring them to the office for your initial appointment.​

Additional Information

Scheduling a Visit

Billing & Insurance

Medical Records

Patient Forms

Patient Portal Login

Get Your Paperwork Out of the Way before Your Appointment.

Patient Forms