Patient Intake Form

Building Blocks Pediatrics Therapy Forms

We appreciate you coming to Building Blocks Pediatrics, LLC for your therapy services! Below are the items we will need to get your child started for therapy. Call us at 770-321-6705 with any questions, we are here to help!

Please download and fill out these forms completely FAX completed forms to 404.551.3891 or MAIL them to us at: Building Blocks Pediatrics, LLC 1230 Johnson Ferry Place, Suite G-10 Marietta, Georgia 30068
Have your Doctor Fax PRESCRIPTION for services to 404.551.3891 Bring original to your first appointment.
First Appointment ~ Once we’ve scheduled your first appointment we reserve this time for you and your child. Please call ASAP if you cannot attend.

The above forms must be signed and brought to your first meeting (mailed or faxed in) with your therapist. Please do not forget your Doctor’s prescription for services.