Comprehensive Internal Medicine

  • Alpharetta: (678) 205-9004
    3180 North Point Parkway
    Suite 303
    Alpharetta, GA - 30005

  • Johns Creek: (770) 622-9002
    3890 Johns Creek Pkwy
    Suite 120
    Suwanee, GA - 30024

Downloadable Forms

 

For your convenience, you may download and complete the following forms prior to your appointment. You will need Adobe Acrobat Reader to view files.
Download it here Acrobat. It's Free.

Please download all of the following forms and bring the completed documents with you to your first appointment
  • New Patient Questionnaire
  • New Patient Data Sheet
  • HIPPA Privacy Statement
  • Office Financial Policy
  • Administrative Services Opt-In
  • Third Party Consent
  • Medical Records Release form
  • Electronic Authorization
  • CIM Follow up visit Review
  • COVID-19 Pre-screening form
  • CPE Previsit Review
  • Well Exam Policy
  • Medicare Well Exam Forms
  • Immunization Consent Form
  • Flushot Information Sheet
  • COVID-19 Vaccine Consent Form
  • Moderna Factsheet - COVID Vaccine
  • V-Safe Information Sheet
  • Pfizer COVID Vaccine Fact Sheet

    • Alpharetta


    • 3180 North Point Parkway
    • Suite 303
    • Alpharetta, GA - 30005
    • Phone: (678) 205-9004
    • Fax: 678-205-9005

    Johns Creek


    • 3890 Johns Creek Pkwy
    • Suite 120
    • Suwanee, GA - 30024
    • Phone: (770) 622-9002
    • Fax: 770-622-9004

    Proud Member Of


    American Board of Internal Medicine
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