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New Patient Admission Forms

Complete before scheduling with us. Choose the form for your child’s service below.

New Patients Start Here ↗ Please review our updated attendance policy click here. ↗ General Admissions Form ↗ General Admission with Upper Extremity Intake Form ↗ ST/OT Feeding Intake Form ↗ Audiology Admission – newborn to 12 month ↗ Audiology Admission – 13 month to school age ↗ Patient update form ↗ Telehealth Consent Form ↗ Payment Consent Form ↗ Medical Records Request and Disclosure ↗
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  • Office: 770-917-5737
  • Fax: 770-917-5740
  • Email: info@blptc.org
  • 4900 Ivey Road, Ste. 1720, Acworth GA 30101
  • Mon. – Thu. – 8:00 AM – 6:00 PM

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