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Phone: 404.659.5909 | Fax: 770.399.9449

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  • Home
  • About
  • Physicians & Clinical Staff
  • Treatments
  • For Patients
    • Insurance
    • Forms
    • Self Help
    • National Opioid Dilemma
    • Schedule an Appointment
  • FAQs
  • Locations
  • News
  • Contact Us

Forms

Print and fill out the applicable forms to save time when you visit our office. If you have any questions, please reach out to us for more information.

Patient Forms

Medical Records Request Form
(English)

Medical History
(English | Spanish)

Notice of Privacy Practices
(English)

Patient Information
(English | Spanish)

Pain Management Agreement
(English | Spanish)

Medicaid Advance Beneficiary Notice of Non-Coverage (ABN)
(English | Spanish)

Informed Consent Regarding After Hours Phone Calls
(English)

Informed Consent Regarding Our In House Lab Services
(English)

Informed Consent for Using Opioids to Treat Pain
(English | Spanish)

Disclosure of Health Information Consent
(English)

New Patient Packet
(English)

EMG / NCS Forms
(English)

Contact Us

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  • Physicians & Clinical Staff
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Our Decatur location has moved!

The new address is:

2785 Lawrenceville Highway
Suite 100
Decatur, GA 30033

Located in the Montreal 2000 Complex inside the 285 Perimeter.

If you have any trouble finding the new location, please call our office at 404.659.5909