Patient Center
Patient Forms
Patients are encouraged to complete their patient information and health history forms before their visit. Please bring the completed forms with you to your appointment.
Patients, please bring the following with you for your appointment:
** NOTE: Adobe Reader is required to view the following documents. Click Here to download. **
- Patient Information Form (Fill in and print)
- Medical Questionnaire (Fill in and print)
- HIPAA Notice of Privacy Practices (Please read)
- Acknowledgement of Privacy Practices (Fill in and print)
- Insurance Card
- Driver's License
Important Information
Office Hours
Monday through Friday 8:30 - 4:30 (varies by location and provider)
Appointment
Call 770-814-8222, Press Option 1 for appointments and be sure to specify which location.
All office visits are by appointment only so that every patient receives the individual attention necessary. Please respect the appointment time you reserve and make every effort to give at least 24 hours notice of any unavoidable cancellations.
*Note: Anyone under the age of 18 must be accompanied by a parent or guardian.
All office visits are by appointment only so that every patient receives the individual attention necessary. Please respect the appointment time you reserve and make every effort to give at least 24 hours notice of any unavoidable cancellations.
*Note: Anyone under the age of 18 must be accompanied by a parent or guardian.
Fees
All co-payments or fees are required on the same day of your appointment. We accept cash, check, Visa & MasterCard.
Insurance Plans
Referrals Needed From PCP
Tricare Prime HMO (ALL)
Aetna Managed Choice (M/C) Some Plans
Tricare Prime HMO (ALL)
Aetna Managed Choice (M/C) Some Plans
Note: This is not a guarantee of coverage, please be sure to check with your insurance company if you are not sure you are covered under any of these plans, or if a referral is needed. We are happy to see you even if we do not take your insurance, however you are responsible for all services rendered.
|
Aetna Managed Choice POS (M/C) Aetna Medicare Advantage HMO Aetna PPO Aetna/US Healthcare HMO/POS Affordable (First Health) PPO America's Health Plan PPO Amerigroup Medicaid Beechstreet PPO BCBS- HMO, POS, PPO, Indemnity BCBS MedicareAdvantage HMO Bellsouth PPO Blue Choice --- PPO, POS, & HMO Capp Care PPO |
Care Improvement Plus Medicare CCN (Community Care Network) PPO Cigna PPO, HMO/POS, Care Network Choice Care (Humana) PPO Coventry HMO/POS Coventry National Network PPO Evercare Medicare Plan Evolutions PPO Federal Employees Program PPO(BCBS) First Health PPO Galaxy Health Network PPO Georgia 1st Network GEHA PPO |
Great West (One Health) HMO, POS, PPO Health Advantage PPO Healthstar PPO/ppo NEXT Health Plan Select HMO/POS Humana HMO, POS, PPO Humana Gold Medicare Plan Medicaid, Traditional & Amerigroup Only Medicare, Traditional & PFFS Plans Medical Resource Network(GA 1st) Multi Plan PPO NovaNet PPO One Health HMO, POS, PPO PHCS-PPO, POS |
ppoNEXT/Healthstar PPOG (Preferred Plan of Georgia) PPO Rail Road Medicare Southcare PPO State Health Plan(United Healthcare) Three Rivers Provider Network(TRPN) Tricare and Tricare Prime HMO Unicare PPO United Healthcare PPO, HMO/POS, EPO USA Managed Care PPO |
© 2010 North Atlanta Dermatology - All Rights Reserved