PATIENT FORMS PACKET
As a new or returning patient (not seen within the last six months), you need to complete the patient forms packet below. Save time in the waiting room! Please print and complete the following forms before your appointment and bring them with you to your appointment. Or arrive 30 minutes before you scheduled appointment time to complete the forms in our office.
If you need an individual form, please choose one below.
Our offices are open from 8:00 am to 5:00 pm, Monday through Friday. We can often accommodate patients for an appointment within 24 hours.
Georgia Pain Management accepts patients with or without referral, according to your healthcare insurance plan. Appointment times are based on medical need and patient convenience. All minors under 18 years of age must be accompanied by a parent or legal guardian in order to be treated by our physician. All new patients or patients who have not been seen at our office within six months are required to arrive 30 minutes prior to their appointment time.
To schedule an appointment at Georgia Pain Management, please contact our office.
If you have a scheduled appointment time and need to reschedule or cancel, please notify our office as soon as possible, so that we may benefit another patient. We will gladly reschedule you a more convenient appointment time. Failure to come to a scheduled appointment without proper advanced notification may result in dismissal from this practice.
Medications refill requests will be addressed in a timely manner. Any requests received after 3:00 p.m. will be addressed the following day, except in emergency situations. Medications will not be refilled after regular office hours or on weekends. Any forms requiring completion for insurance "prior approval" for prescriptions may delay the prescription being filled. Please give us as much notice as possible for refills.
We reserve the right to decline to refill medications under the following circumstances:
We appreciate the opportunity to help you, and thank you for abiding by our prescription policy.
FEES & INSURANCE
Charges for medical services and procedures are due and payable at the time of service. Our fees are within the customary range for the Atlanta metro area. Our staff will be happy to answer any questions about our services or fees.
We have contracts with many insurance companies and managed care organizations, and we will typically file claims for all services under these programs. To find out if our office accepts your insurance plan, please contact our office.
Please be prepared to pay co-payments and/or deductibles at the time of service. For your convenience we accept cash, checks, Visa, American Express, Discover and Master Card.
Insurance companies often request information describing an injury before they will reimburse our office or surgery center for your treatment. If this applies to you, we would expect your cooperation in providing the requested information as soon as possible. We will be happy to answer any questions or assist you in this process as necessary.
Your insurance coverage is a contract between you and your insurance company. Prior to your appointment, you should review your benefits and question any possible exclusions on your policy. Patients may be responsible for the difference between what the insurance company allows and what they pay for your physician visits and pain management procedures.
We appreciate your cooperation.