About Your Visit
Learn more about what to expect at your appointment including arrival times, paperwork, and a list of items to bring.
“No Surprise Act” Information
Forms for Printing
If you need an individual form from the packet above, please choose the form from the list below.
- 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)