© 2018 ESE Telehealth, LLC

1523 Old Valdosta Road, Ray City, GA  31645

For Schools: 877-755-2212  General Public: 877-543-7221

A little bit of time now will save you a lot of time later! We ask that you print and complete these forms on behalf of your child/children whom you would like to have the opportunity to take advantage of on-site telehealth services at their school. By reading and completing these forms now, you can save your family valuable time away from work and school by allowing your child/children to be seen, diagnosed and treated at school by our medical professionals. Please create an account in our Patient Portal or complete and return the following forms by emailing them to medicalrecords@esetelehealth.com, by faxing them to 877-543-7221.