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Medical Forms

New Patient Forms

New Patient Registration (pdf) - Bring in your insurance card and this form to your first visit.

Notice of Privacy Practices Form (pdf)
(There is a formatting problem with this document that we are working to resolve. We kindly request that you obtain a correctly formatted copy of the document when you arrive at our clinic for your office visit.)

Patient Acknowledgement & Consent Form (pdf)

Clinic Policy On Managed Insurers Form (pdf)

Established Patient Forms

Patient Information Update Form (pdf) - Have you moved? Changed health insurance? Changed phone numbers? Complete this form before your next visit.

Patient Acknowledgement & Consent Form (pdf)

Clinic Policy On Managed Insurers Form (pdf)

Please note: These forms require Adobe Acrobat reader to open. Don't have Acrobat Reader? Download it now.

Gwinnett Clinic is not equipped to treat patients with serious, limb- or life-threatening illnesses, accidents, or other emergencies. Information presented on this site is subject to change without prior notice.