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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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  • About
  • Physicians & Clinical Staff
  • Treatments
  • For Patients
  • FAQs
  • Locations
  • News
  • Contact Us
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COVID-19 Alert

We are making sure that no patient enters the waiting room who has a fever, sore throat, or a cough. We respectfully request every patient wears a mask and use frequent hand sanitizer. We have filtration systems in the waiting room. We wipe down the waiting room and each exam room completely after each patient. If you have to give a urine for a drug screen, our bathrooms are sanitized after each visit. Injections in the office are safe to perform. We are here to keep you safe!

Please be patient with us as we follow CDC Guidelines associated with the COVID-19 virus to ensure your safety and that of your Providers.