Payment Options
Patient Portal FAQ
Forms and Policies
Checkup Info
Immunization Schedule
Emergency Info
Appointment Info
Medicaid
Effective October 1, 2016, Dothan Pediatric Clinic will charge for the completion of forms when not completed at the time of service.
As an alternative you can use your patient portal account to request forms at NO CHARGE. If you do not have a patient portal account, please call us at 334.793.1881 (2699).
FMLA
$20
10 days
School Medication Forms
$10
School Excuses for Past Visits
Letters
Miscellaneous Forms
Patient Profile for Social Security
$5
1 day
LIHEAP - Power Assistance
An additional $20 will be charged for forms completed the same day (LIHEAP not applicable).
View Medical Release Form
Alabama High School Athletic Association Sports Physical Form
Florida Sports Physical Form
Fort Rucker Sports Physical Form
Georgia Sports Physical Form
