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Laura Bleekrode, MD
Tashawna Stokes, MD
Roswell Office: 770.664.4430
Cumming Office: 678.947.4588
Please print these forms and bring with you to your first appointment.
Don't worry if you forget, we have a copy at the office for you as well.
If you are switching to our practice from another pediatrician, please bring this form with you to your first appointment so we may request your previous records.
*Note: There are 2 forms attached to this link, one for transferring to our practice and one
for transferring out, please make sure you are filling out the correct one.
We have provided a copy of our Vaccine Agreement form so you may look over it if you are interested in following an alternate or delayed vaccine schedule for your children.
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