You will need Adobe Reader to view these forms and fill out online. The forms that must be filled out are Patient Information Form and General Consent Form, the others as needed. You will electronically sign these forms and it will be securely e-mailed to our office. To save time please do this at least two days prior to your appointment. Thank you!
Patients are encouraged to complete their patient information at least 2 days or sooner before their visit.
Patient Information Form (use Google Chrome or Firefox Web Browsers)Medical QuestionnaireGeneral Consent FormNotice of Privacy Practices (please read-Rev. 9-23-14)Minor Consent FormInsurance CardDriver’s LicenseAuthorization to Release Information to Third Parties, or Release Records to Patient/Guardian or Record Release for Patient*** IMPORTANT INFORMATION ***
Monday through Friday 8:30 a.m. – 4:30 p.m. (varies by location and provider)
For Appointments Call 770-814-8222, Press Option 1 and be sure to specify which location.
All office visits are by appointment only so that every patient receives the individual attention necessary. Please respect the appointment time you reserve and make every effort to give at least 24 hour notice of any unavoidable cancellations.
*Note: Anyone under the age of 18 must be accompanied by a parent or guardian.
Fees – All co-payments or fees are required on the same day of your appointment. We accept cash, check, Visa, Master Card, & Discover. American Express We take Care Credit ($1,000 minimum)Insurance Plans –Referrals Needed From PCP Tricare Prime HMO (ALL) Aetna Managed Choice (M/C) Some Plans and United Healthcare Compass.
Note: This is not a guarantee of coverage, please be sure to check with your insurance company if you are not sure you are covered under any of these plans, or if a referral is needed. We are happy to see you even if we do not take your insurance, however you are responsible for all services rendered.
PREVENTATIVE CARE and DERMATOLOGY Form
- Aetna Managed Choice POS (M/C)
- Aetna Medicare Advantage HMO
- Aetna PPO
- Aetna/US Healthcare HMO/POS
- Affordable (First Health) PPO
- America’s Health Plan PPO
- Amerigroup Medicaid
- Ambetter
- Beechstreet PPO
- BCBS/Anthem- HMO, POS, PPO, Indemnity
- BCBS MedicareAdvantage HMO
- Bellsouth PPO
- Blue Choice — PPO, POS, & HMO
- Capp Care PPO
- Care Improvement Plus Medicare
- CCN (Community Care Network) PPO
- Cigna PPO, HMO/POS, Care Network, Cigna Healthsprings
- Choice Care (Humana) PPO
- Coventry HMO/POS
- Coventry National Network PPO
- Evercare Medicare Plan
- Evolutions PPO
- Federal Employees Program PPO(BCBS)
- First Health PPO
- Galaxy Health Network PPO
- Georgia 1st Network
- GEHA PPO
- Great West (One Health) HMO, POS, PPO
- Health Advantage PPO
- Healthstar PPO/ppo NEXT
- Health One Alliance PPO
- Health Plan Select HMO/POS
- Humana HMO, POS, PPO
- Humana Gold Medicare Plan PPO
- Medicaid, Traditional & Amerigroup Only (Not Wellcare)
- Medicare, Traditional & PFFS Plans
- Medical Resource Network(GA 1st)
- Multi Plan PPO
- NovaNet PPO
- One Health HMO, POS, PPO
- PHCS-PPO, POS
- ppoNEXT/Healthstar
- PPOG (Preferred Plan of Georgia) PPO
- Rail Road Medicare
- Southcare PPO
- State Health Plan(United Healthcare)
- Three Rivers Provider Network(TRPN)
- Tricare and Tricare Prime HMO
- Unicare PPO
- United Healthcare PPO, HMO/POS, EPO
- United Healthcare Compass (needs referral from your PCP)