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.
- Welcome Letter
- Registration Form
- Breast & Medical History
- Financial Policy
- Missed Appointment/Late Cancellation/ No Show Policy
- Memo for Billing Changes Effective 1.3.2022
- Authorization for Use & Disclosure of Protected Health Information
- Authorization for the Release of Medical Records (Medicopy)
- Notice of Privacy Practices
- FMLA Form Completion 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
- ADMIN CONCEPTS
- AETNA CHOICE, CHOICE POS II, HMO, PREMIER, EPO SELECT OA, MC OA, & PPO
- AETNA MEDICARE HMO & PPO
- AETNA MEDICARE SIGNATURE PLAN PPO
- AETNA WELLSTAR
- AITHER
- ALLEGIANCE
- ALLIANCE THROUGH MARKETPLACE
- ALLIED
- ALLSAVERS UHC & ALLSAVERS
- ALLSTATE AETNA OPEN CHOICE PPO (MERITAIN)
- AMBETTER (GEORGIA ONLY), AMBETTER SELECT (WELLSTAR ONLY), AMBETTER CORE, & AMBETTER VIRTUAL ACCESS
- AMERIBEN
- ANTHEM BCBS HMO, & OPTIONS POS/BLUE CHOICE OPTIONS POS
- ANTHEM EMPIRE BCBS
- ANTHEM BCBS MCR ADV
- ANTHEM MEDICBLUE PRIME SELECT
- ANTHEM BCBS SMART VALUE
- ANTHEM BCBS PATHWAY HMO,
- PATHWAY X HMO, & PATHWAY GUIDED ACCESS
- ANTHEM BCBS PPO, OA POS, OA HMO, FEDERAL
- ASSURANT
- BCBS OA HMO, OA POS, PPO, CARE FIRST BLUE CHOICE BC ADV OA, MCR, FEDERAL, HIGHMARK, HORIZON, WELLMARK PPO, EMPIRE EXCELLUS, & REGENCE
- BEECH STREET (ALL PLANS)
- BIND BENEFITS / UHC
- BOONE (FIRST HEALTH NETWORK)
- CAPITAL BCBS
- CAREFACTOR (ZELIS/1ST HEALTH NETWORK)
- CARE FIRST BLUE CHOICE BC ADV OA, & BC ADV HYBRID PPO
- CARE IMPROVEMENT PLUS
- CHAMPVA
- CIGNA HMO CONNECT, CIGNA CONNECT, CIGNA MCR, & CIGNA CHOICE FUND OA
- CIGNA HEALTHSPRING HMO MCR & PREFERRED MCR HMO
- CLOVER HEALTH MCR ADV
- CLOVER WALMART ENHANCED PPO
- CORE SOURCE - CIGNA
- COVENTRY PPO, OA, & MCR ADVANTRA
- CREDENCE BCBS OA, PPO, HMO, & OPTIONS POS
- EMBLEM HEALTH
- EMPIRE ANTHEM BCBS AND EMI HEALTH
- FIRST HEALTH (PPO ONLY, NOT HMO)
- FREEDOM LIFE/BCBS
- GEHA
- GHI
- GOLDEN RULE
- GPA PHCS
- GREAT WEST
- HEALTHEZ
- HEALTHCOMP PHCS
- HEALTH ONE ALLIANCE
- HEALTH PARTNERS OA PLUS
- HEALTH PLAN
- HEALTHSCOPE BENEFITS
- HMA LLC
- HUMANA HMO, GOLD MCR HMO, PPO, OA NPOS, MCR GOLD PPO, OA NPOS NS HOSP LEVEL 2, & MEDICARE CHOICE
- INDEPENDENCE ADMINISTRATORS
- INDEPENDENT HEALTH (1ST HEALTH NETWORK)
- INTL BENEFITS ADMIN
- KAISER DUAL CHOICE PPO
- KAISER MCPHCS, & KAISER MULTIPLAN
- LIBERTY HEALTHSHARE
- LIFEWELL
- MEDICARE(PART B) & MEDICARE RAILROAD(PART B)
- MEDASSURANCE
- MEDCO
- MEDICA - UHC
- MEDI-SHARE PHCS
- MED PLUS (2ND TO BCBS)
- MERITAIN
- MUTUAL OF OMAHA
- MVP MULTIPLAN & MULTIPLAN PHCS
- NALC/CIGNA
- ONE HEALTH PLAN
- OSCAR
- OXFORD UHC
- PHILADELPHIA AMER LIFE
- PIEDMONT (TIER 2 )
- PREMERA BCBS
- RAILROAD MEDICARE(PART B)
- REGENCE BCBS
- RELIANT
- SAMARITAN GIVEN MINISTRIES
- STUDENT RESOURCES/UHC
- SUREST UHC
- THE HEALTH PLAN
- TPA
- TRICARE FOR LIFE, PRIME, SELECT, & STANDARD
- TRUSTMARK HEALTH (BUT NOT NORTHSIDE EMPLOYER)
- UHC HARKIN & UHC ALLSAVERS
- UHC AARP MEDICARE COMPLETE PPO
- UHC MCR ADV PPO, & DUAL COMPLETE(PPO ONLY)
- UHC CHOICE PLUS, CHOICE HMO, & VACCN OPTUM
- UHC CORE
- UHC GA INDIVIDUAL EXHANGE HMO
- UHC GOLDEN RULE
- UHC HERITAGE PLUS & EMPIRE
- UHC HMO(NOT MEDICARE), & CHOICE HMO
- UHC NAVIGATE
- UHC NEXUS, & UHC GA INDIV EXCHNG BENEFIT PLAN HMO
- UHC OXFORD (THROUGH CHOICE PLUS NETWORK)
- UHC SELECT, & UHC SELECT PLUS
- UMR
- UNITED HEALTH ONE
- WEBTPA