New Patient Forms
To be filled out prior to appointment
- Health History
- Medication List
- Authorization for Disclosure of PHI ( Medical Records RELEASE Form for Workers Comp Patients ONLY)
To be signed at check-in (please do not complete prior to arrival)
- Patient Information
- Financial Policy
- Phone Call Policy
- Patient Communication Authorization
- Notice of Privacy Practices
- Controlled Substance Agreement Form
All Forms
- Authorization for Disclosure of PHI (Athens Spine Center will RELEASE/send your medical records to another entity)
- Authorization for Disclosure of PHI (Athens Spine Center will REQUEST/obtain your medical records from another entity)
- Acknowledgment of Notice of Privacy Practices (Includes Consent for Disclosure to Family)
- Authorization for Disclosure of PHI ( Medical Records RELEASE Form for Workers Comp Patients ONLY)
- Controlled Substance Agreement Form**
- Communication Authorization
- Financial Policy
- Georgia Low THC Oil Registry Waiver
- Health History
- Medication List
- Outpatient Consent for Procedure
- Patient Communication Authorization
- Patient Information
- Patient Request for Treatment Release
- Phone Call Policy
- Post Procedure Instructions
- Medical Record Fees
- Patient Grievance Form
- Request for Alternate Communications
- Request for Amendment of PHI
- Request for an Accounting of Disclosures
- Request to Restrict