Patient Document Page


Advanced Directive Questionnaire

An Advanced Healthcare Directive, also known as a Living Will, is a legal document in which a patient specifies what actions should be taken for their health is they are no longer able to make decisions for themselves. Use the link provided below to print and complete a Georgia Advance Directive for Health Care. We are unable to be a witness for this document.

Georgia Advance Directive for Healthcare


Patient Bill of Rights

The Patient Bill of Rights lists information that we are required to provide to a patient each time that they have an appointment at this Facility.

ASPC Bill of Rights

Quad A Patient Rights Form


Outpatient Procedure Consent

All patients must sign a consent that explains what procedure will be completed. This document will have the type of procedure, the location of the injection and general information regarding your procedure.

Outpatient Procedure Consent


Post Procedure Discharge Instructions

Once your procedure has been completed you will be given instructions on what you can expect for the following few days. Please read these carefully and if there are any questions at all, please contact our office immediately.

Post Procedure Discharge Instructions


Pregnancy Test Waiver

All females under the age of 50 are required to take a pregnancy test. If requested, this form can be signed instead of taking the pregnancy test.

ASPC Pregnancy Test Waiver


Financial Assistance Application

Our Medical Financial Assistance program allows us to provide assistance to eligible patients unable to pay for their medical care. Eligible patients can receive free or reduced cost services based on their income level as compared to the Federal Poverty Guidelines. To be considered for this program this form MUST be completed in its entirety. Submission of the application does not guarantee any assistance will be provided.

Financial Assistance Application

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