Consult, Profile and Application Forms

LOCATIONS

Main Office
1150 Lake Hearn Drive, Suite 400
Atlanta, GA, 30342

Alpharetta Office
North Crescent Medical Center
11975 Morris Road, Suite 220
Alpharetta, GA 30005

Lawrenceville Office
Gwinnett Medical Center Campus
500 Medical Center Blvd, Suite 330
Lawrenceville, GA 30046

Fayetteville Office
1267 Highway 54 West
Suite 3200
Fayetteville, GA 30214

Forms

New Patient Registration

You can register online using our secure system.
All necessary forms can be completed once logged in to the registration area.

1) New Patient Appointment/Preliminary Registration Form.
This form will allow you access to our registration system and allow us to contact you with a new patient appointment.

2) Female Registration.
We use the female partner's contact, billing and insurance information so please start with this form. (NB. If you are coming without a female partner please complete the Male Registration instead).

3) Female Medical History.
Please complete these questions for the female partner.

4) Male Medical History.
Please complete these questions for the male partner.

If you require any assistance or if you have any questions about registration please call Mary 404-459-3515.

Printable Patient Registration Form
The printable version of the patient registration form is available for download in Acrobat Reader (.pdf) Format. You can either double click on the link and view it right from your web browser, or you can right click the link, select Save Target As, and save it to your hard drive.

Please fax the form asap to 404-256-9497.
If you require any assistance or if you have any questions about registration please call Mary 404-459-3515.

Recipient registration and consent forms
All forms below are in PDF format. If you do not have Adobe Reader, please click here to download for free