Internal Medicine and Pediatric Clinic of New Albany, MS

In the links to the right, you'll find a wealth of helpful information. We encourage you to use these to your benefit as needed. Please check back as we will be adding to this page periodically.

New Patients
We want your visit to The Internal Medicine and Pediatric Clinic to be convenient.. You can download, print, and fill out the following forms prior to your visit to help make your time with us as efficient as possible. Please read the New Patient letter even if you don't intend to fill out forms prior to your visit. Simply select the following links and print them from your browser. You will need Adobe PDF Reader, a free program, if you do not have it installed already (get one here).

Not all forms will pertain to every patient. However, there are 4 essential forms that every patient MUST complete: Patient Info Sheet, Health Info Sign-Off Form, Treatment Consent Form and the Financial Policy.

New Patient Letter (please read)
Patient Info Sheet
HIPAA Documentation
Health Info Sign-Off Form
Treatment Consent Form
Financial Policy
WCC & Immunization Policy
Circumcision Policy
Webview Disclaimer
Webview Consent
Release of Medical Records

Notice | Beginning 01/01/2011 everyone will be required to present a current copy of their insurance card at every visit.

English	Español
Pediatric Information An extensive listing of helpful pediatric documents	Spanish Translations
Adult Education Helpful information about common ailments.
ADHD Information Parent Assessment Parent Follow-up Teacher Assessment Teacher Follow-up

IMPC
488 W. Bankhead Street
New Albany, MS 38652

Phone: 662.534.0898
Fax: 662.534.8905

Regular Office Hours
Mon-Fri: 8:30AM-5:00PM

Looking for something?
Can't find what you're looking for on our website? If you have a question for us, please don't hesitate to contact us. We'll be glad to be of assistance.