JPL Family and Pediatric Medicine
JPL Family and Pediatric Medicine
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Call for appointments at
334-291-5255

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Forms

  • JPL REGISTRATION FORM
  • JPL HEALTH HISTORY QUESTIONNAIRE – ADULT MALE
  • JPL HEALTH HISTORY QUESTIONNAIRE – ADULT FEMALE
  • JPL HEALTH QUESTIONNAIRE FEMALE 10-18 YEARS
  • JPL HEALTH QUESTIONNAIRE MALE 10-18 YEARS
  • JPL NEW PEDIATRIC QUESTIONNAIRE
  • NEWBORN REGISTRATION QUESTIONNAIRE
  • JPL CONSENT TO RELEASE
  • AUTHORIZATION TO RELEASE
  • JPL HIPAA CONSENT

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DISCLAIMER: Please note that an individual seeking treatment is not considered a patient until the practice has completed a preliminary assessment, that all enrollment paperwork has been submitted, and the individual has been notified of his/her acceptance.

Address

Jacksons Point of Light Family Medicine, Inc.
1810 Stadium Drive
Suite 210
Phenix City, AL 36867
ph: (334)291-5255
alt: (334)297-1085
fax: (877)395-0710
contact@jplmed.com Disclaimer: This email is not for emergency communication. If you are a patient, please contact our office directly with the numbers listed above. If our office is closed ,please dial 911 or go to your nearest urgent care or emergency room facility.

Hours

Mon – Thr: 8:30am – 4:30pm
Fri: 8:30am – 12:30pm

Call 334-297-1085 for further assistance, we will provide you with the best care…, with a smile.

  • Home
  • Medical Services
  • Pediatrics
  • Weight Management Services
  • Contact Us
  • About Us
  • Forms
© JPL Family and Pediatric Medicine 2021