Refill A Prescription

Patient Portal

24/7 Access with My Kid’s Chart

You may now access portions of your child’s medical records, communicate with the team, pay your bill, and more with our new patient portal, My Kid’s Chart.

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This site is secure, so rest assured your data is protected and used only by Green Hills Pediatric Associates.
Patient’s Full Name
Date Of Birth
Primary Physician
Daytime Phone
Other Phone
Email Address Please check your e-mail address carefully.
Medication Name
Dosage
Frequency
Days Supply
Controlled Medication? Yes No
2nd Medication Name
Dosage
Frequency
Days Supply
Controlled Medication? Yes No
3rd Medication Name
Dosage
Frequency
Days Supply
Controlled Medication? Yes No
Delivery Method Pick Up At GHPA Pick Up At Pharmacy

Pharmacy Name

Pharmacy Address

Pharmacy Phone

Mail

Recipient Name

Address