New Patients

A young doctor fills in a form with his patient's data.
A cheerful doctor holds the baby boy on an electronic scale.

Pediatrician Clinic in Germantown

We are excited and honored that you are considering us for your child’s medical home!

We have loaded all our forms on to our web site. Filling paper forms at the office can be time-consuming, especially if there is a little one running around in the waiting room. 

Filling out a form online, before your visit, means we have all the information we need — including any questions or concerns that you’d like to talk about with your provider. The forms are secure, and your information is always encrypted.

QR code for registration form under 18 years

Registration Form (Under 18)

QR code for registration form over 18 years

Registration Form (Over 18)

Insurance Accepted

We accept most Health Care plans, call your insurance company for clarification.

  • Aetna
  • Blue Cross & Blue Shield
  • Blue Care
  • Cigna
  • MedBen
  • Tricare
  • United Healthcare
  • United Healthcare Community Plan

Best Pediatric Care in Tennessee

Please click the corresponding link below to complete the appropriate ASQ for your child's age before your appointment. This way, we will be ready to go when we see you in the office and the exam room!

What to Bring

We ask that you bring the patient's insurance card, your ID card, such as a valid driver’s license, a list of medications with the dosage, and any previous medical records, including shot records.

Germantown Pediatric and Family Medicine © All Rights Reserved.

Created by DearDoc.