Office 770.760.1394 | Fax 770.760.8414
Hours: M 9a-12p & 3-6p | W & F 9a-12p & 3-6:30p

New Patient Paperwork

To help speed up your initial visit at our office, please select the type of paperwork that best fits your situation, print them and fill them out.  Notice there are 2 forms for each of the 4 situations.  Both must be completed.

If you choose to complete your paperwork in advance, please let our staff know when you call us at 770-760-1394 to schedule your appointment.

MAKE SURE you bring your completed forms with you on your first office visit!

Pediatric

kids-jumping

Pediatric
Minors under 18 years of age 

Download Pediatric New Patient Form

Pediatric-Auto Accident
Minors under 18 years of age

Download Pediatric Auto Accident New Patient Form

In addition to the paperwork, the minor child’s parent / guardian / responsible party must bring the following with them on the first visit:

Photo ID:  A state issued driver’s license will do.

Health Insurance Card:  So that we may verify your child’s insurance benefits.  Keep in mind we will need the member/subscriber’s information to do so.

If the minor child was involved in an auto accident, please bring the following, also:

Police Report:  Official documentation of accident (if police came to the scene).

Proof of Coverage or Attorney’s Information:  Information on the driver/owner of vehicle’s auto insurance that will cover your care or information on the attorney handling your case (if applicable).

Adults

man-wheelchair

Adult

Cash, Insurance, Work Injury, & Medicare

Download Adult New Patient Form

Adult-Auto Accident

Auto Insurance Coverage

Download Adult Auto Accident New Patient Form

In addition to the paperwork, you must bring the following on the first visit:

Photo ID:  A state issued driver’s license will do.

Health Insurance Card:  So that we may verify your insurance benefits.  Keep in mind we will need the member/subscriber’s information to do so.

If you were involved in an auto accident, please bring in the following also:

Police Report:  Official documentation of accident (if police came to the scene).

Proof of Coverage or Attorney’s Information:  Information on the driver/owner of vehicle’s auto insurance that will cover your care or information on the attorney handling your case (if applicable).

MAKE SURE you bring your completed forms with you on your first office visit!

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