About Your Visit
Learn more about what to expect at your appointment including arrival times, paperwork, and a list of items to bring.
Patient Forms
We ask that you complete your new patient forms packet prior to your appointment. You can print and complete the PDF forms below, or you can visit our patient portal
“No Surprise Act” Information
Complete Forms Online
To complete forms online, please visit our patient portal.
Forms for Printing
New Patients
Please print and complete the New Patient Forms Packet before your appointment. You may fax them to 678.370.0371 or bring them with you to your appointment.
If you choose to complete the forms in our office and are a new patient, please arrive 30 minutes before your scheduled appointment.
If you need an individual form from the packet above, please choose the form from the list below.
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- Welcome Letter
- Patient Information Form
- Breast & Medical History
- Financial Policy
- Memo for Billing Changes Effective 1.3.2022
- Notice Patient Consent of Privacy Practices & Authorization for Use & Disclosure of Protected Health Information (PHI)
- Medicopy Authorization for the Release of Medical Records
- Medicopy Disability/FMLA Intake Form and Authorization
- Medicopy Flyer with Contact Information
Established Patients
If you are an established patient, please arrive 15 minutes before your scheduled appointment to update the necessary paperwork.
Insurance Information
- AARP MCR SUPPLEMENT & AARP MCR CHOICE PPO
- ACS BENEFIT SVCS (PHCS or MULTIPLAN NETWORK)
- ADMIN CONCEPTS
- AETNA PLANS: CHOICE, CHOICE POS II, PREMIER, EPO SELECT OA, MC OA, HMO & PPO
- AETNA MEDICARE HMO & PPO
- AETNA MEDICARE SIGNATURE PLAN PPO
- AETNA WELLSTAR TIER 1
- AITHER
- ALLEGIANCE
- ALLIANCE THROUGH MARKETPLACE
- ALLIED
- ALLSAVERS UHC & ALLSAVERS TIER 1
- ALLSTATE AETNA OPEN CHOICE PPO SHORT TERM MEDICAL (MERITAIN NETWORK)
- ALTRISK (PHCS NETWORK)
- AMBETTER PLANS(GEORGIA ONLY): SELECT (WELLSTAR ONLY) LIST OF PLANS; CORE LIST OF PLANS; VIRTUAL ACCESS LIST OF PLANS
- AMERIBEN
- ANGLE HEALTH (CIGNA PPO NETWORK)
- ANTHEM EMPIRE BCBS
- ANTHEM BCBS MCR ADV PLANS: MEDIBLUE MCR PPO; MCR PPO; MEDICBLUE PRIME SELECT
- ANTHEM BCBS SMART VALUE
- ANTHEM BCBS PATHWAY HMO; PATHWAY X HMO; GUIDED ACCESS
- ANTHEM BCBS PPO, OA POS, OA HMO, HMO, FEDERAL; OPTIONS POS; BLUE CHOICE OPTIONS POS
- ASR HEALTH BENEFITS (MULTIPLAN/CIGNA NETWORK), OR (AETNA SIGNATURE ADMINISTRATORS NETWORK)
- ASSURANT
- BCBS PLANS: OA HMO, OA POS, PPO, CARE FIRST BLUE CHOICE BC ADV OA, MEDICARE ADV EXCEPT D-SNP, FEDERAL, HIGHMARK, HORIZON, WELLMARK PPO, EMPIRE EXCELLUS, REGENCE; PREMERA; CREDENCE; SELECT PPO
- BEECH STREET (ALL PLANS)
- BIND BENEFITS / UHC
- CAPITAL BCBS
- CARE FIRST BLUE CHOICE BC ADV OA; BC ADV HYBRID PPO; PPO
- CARE IMPROVEMENT PLUS
- CHAMPVA
- CIGNA PLANS: HMO CONNECT; GEORGIA CIGNA CONNECT; MEDICARE ADVANTAGE; CHOICE FUND OA; OA PLUS; LUCENT HEALTH; PPO-S PLAN; PIEDMONT OPEN ACCESS PLUS TIER 2
- CIGNA HEALTHSPRING HMO MCR; PREFERRED MCR HMO; TRUE CHOICE SAVINGS MCR PPO; CIGNA MCR EXCEPT D-SNP
- CIGNA+OSCAR OA PLUS
- CLOVER HEALTH MCR ADV
- CLOVER WALMART ENHANCED PPO
- CORE SOURCE - CIGNA
- COVENTRY PPO, OA & MCR ADVANTRA
- CREDENCE BCBS OA OR PPO
- EBPA
- EMBLEM HEALTH
- EMI HEALTH (AETNA SIGNATURE ADMINISTRATORS)
- EMPIRE ANTHEM BCBS AND EMI HEALTH
- FIRST MEDICAL NETWORK
- FLEXWORK(UHC CHOICE ALL SAVERS NETWORK)
- FREEDOM LIFE/BCBS
- FREEDOM LIFE/US HEALTH GROUP
- GEHA
- GHI
- GOLDEN RULE
- GPA PHCS
- GRAVIE ADMINISTRATIVE SERVICES
- GREAT WEST
- HEALTHEZ
- HEALTH COMP (PHCS NETWORK)
- HEALTH ONE ALLIANCE
- HEALTH PARTNERS OA PLUS
- HEALTH PLAN
- HEALTHSCOPE BENEFITS
- HMA LLC (EXCEPT LIMITED BENEFIT PLAN)
- HUMANA GOLD MCR HMO
- HUMANA PLANS: PPO; OA NPOS; MCR GOLD PPO; HUMANA OA NPOS NS HOSP LEVEL 2; HUMANA MEDICARE CHOICE; OA HMO PREMIER; HMO
- HUMANA MCR EXCEPT D-SNP
- IMAGINE 360 (MULTIPLAN NETWORK)
- INDEPENDENCE ADMINISTRATORS BCBS
- INTL BENEFITS ADMIN
- KAISER DUAL CHOICE PPO
- KAISER MCPHCS & KAISER MULTIPLAN
- LIBERTY HEALTHSHARE(LHS)
- LIFEWELL
- LUCENT HEALTH CIGNA
- MEDICARE PART B & MEDICARE RAILROAD PART B
- MEDASSURANCE
- MEDCO
- MEDICA - UNITED HEALTHCARE PRODUCT
- MEDISHARE PHCS
- MED PLUS (2ND TO BCBS)
- MERITAIN
- MULTIPLAN NETWORK (SOME PLANS. NOT LIMITED BENEFIT PLANS)
- MUTUAL OF OMAHA
- MVP MULTIPLAN & MULTIPLAN PHCS
- NALC/CIGNA
- ONE HEALTH PLAN (ALL HEALTH PLANS)
- OSCAR PLANS: SIMPLE; EPO; CLASSIC
- OXFORD UHC
- PERFORMANCE HEALTH (PHCS NETWORK)
- PHILADELPHIA AMER LIFE; PHILADELPHIA AMER LIFE LIMITED BENEFIT PLAN
- PIEDMONT OPEN ACCESS PLUS (TIER 2 )
- PROVIDENCE HEALTH (CIGNA NETWORK)
- RELIANT
- STUDENT RESOURCES/UHC
- SUREST UHC
- THE HEALTH PLAN
- TPA
- TRICARE PLANS: PRIME, SELECT, STANDARD, & FOR LIFE
- TRUSTMARK HEALTH (BUT NOT NORTHSIDE EMPLOYER)
- UHC AARP MEDICARE COMPLETE PPO
- UHC ALLSAVERS
- UHC GOLDEN RULE
- UHC HARKIN
- UHC MCR ADV PPO EXCEPT D-SNP DUAL COMPLETE
- UHC PLANS: SELECT; SELECT PLUS; SHARED SERVICES; CHOICE; CHOICE PLUS; CHOICE HMO; VACCN OPTUM; CORE; HERITAGE PLUS; EMPIRE; OXFORD (THROUGH CHOICE PLUS NETWORK); HMO(NOT MEDICARE); STUDENT RESOURCES; NAVIGATE; GA INDIVIDUAL EXCHANGE BENEFIT HMO; NEXUS
- UMR
- UNITED HEALTH ONE
- VAULT/AMPS (PHCS NETWORK)
- WEBTPA
- WELLNET (AETNA CHOICE POS II NETWORK)
- WELLNET HEALTHCARE (MULTIPLAN & PHCS NETWORK)