Request A Health Form

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.

Login or register to request an appointment,
a prescription refill, or a health form.

Login Register

Need to send us a form? Please visit our Secure Form Upload page.

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
Chart/Parent Name
Daytime Phone
Other Phone
Email Address

Please check your e-mail address carefully.
Type Of Form Needed

Need a form not listed above? Please visit our Secure Form Upload page to upload the form.
Delivery Method  Mail
 Email
 Fax
 Pick Up

Recipient Name