New Patient Registration

We look forward to welcoming your family to SouthernMED Pediatrics. Completing your child’s registration is the first step toward establishing care. Our three-step process will guide you through registration, scheduling, and preparing for your child’s first appointment.

Registration Process

BEFORE YOU BEGIN

Please review this information before starting your registration.

The New Patient Registration Form is intended for families who are new to SouthernMED Pediatrics and have never been seen at any of our locations. Review the steps to understand what to expect before getting started.

  • Existing patients: Please do not complete this form. Use online scheduling or contact your preferred office for assistance.
  • Sick new patients: Skip this form if you have a sick or immediate care need; call your preferred office directly.
  • Expectant mothers: Please wait to complete this form until after your baby is born and has an official date of birth.
Start Registration

Step 1

Confirm Eligibility

Only complete this form if your child has never received care at a SouthernMED Pediatrics location or you do not have an immediate (24-48hr) need for care.

Step 2

We Review Your Submission

Our team will review your submission within one business day and verify that your child does not already have a patient record with SouthernMED Pediatrics.

Step 3

Schedule Your Visit

Once your child’s registration is accepted, we’ll send you a text confirmation with instructions for scheduling their first visit online, by text, or over the phone.