Patient Forms

For our new patients and patients who have not been seen in our office within the last 12 months, please click on the link below, print the packet and bring the completed forms with you to your appointment.

 

Consult Request Form

 

Adult Patient Form Packet

Minor Patient Form Packet (Patients Under 18)

 

Notice of Privacy Practices

 

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Insurances

Insurances We accept

Medicare, Railroad Medicare

Blue Cross Blue Shield

United Healthcare

Humana, Humana Military

Cigna

Tricare

Veterans Administration

Multiplan

Aetna

Coventry

Secure Health

Meritain

United Claims Solutions

1st Medical Network

*Don't see your insurance?
Call us at 888-881-9602
to check coverage.


Feedback

We greatly value your feedback on our customer service and want to know how we can serve you better. If you would like us to contact you back regarding your experience at our office, please leave your name along with the date and time of your appointment.

This online feedback form is for customer service related comments only. For any clinical questions or concerns, please contact the office where you were seen (see the Contact Us tab for your office phone number). For billing questions, please contact our billing department at 478-328-0281.

Visit GaDerm.com for additional information and services.