Delivering Exceptional Healthcare for Every Family



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.

General New Patients1


General New Patients2

Please navigate to our home page to complete your registration form, and please go to our Before Your Visit tab to complete the appropriate ASQ for your child's age prior to your appointment. This way, we’ll be ready to go when we see you in the office, and in the exam room! Please call your insurance company and our office to make sure that we are able to verify insurance. 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
3180 Professional Plaza, Suite 111
Germantown, TN 38138
Phone: 901-582-8876
Fax: 901-861-7736

Office Hours

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