Patient Forms
Notice of Privacy Practices
Buckhead Internal Medicine’s Notice or Privacy Practices describes how your medical information may be used or disclosed. Please review this document carefully. You may obtain a paper copy of this Notice upon request.
New Patient Registration Form
You may fill out this form in advance of your visit to save time at check in. This form is required on your first visit to Buckhead Internal Medicine.
HIPAA Patient Consent Form & Administrative Policies
Each patient must sign a Patient Consent Form/Administrative Policy. The consent form allows Buckhead Internal Medicine permission to use protected healthcare information about you in order to carry out treatment, payment and general healthcare operations. This form also describes our administrative policies.
Medical Information Release to Buckhead Internal Medicine
This form allows Buckhead Internal Medicine obtain protected medical information on your behalf.
Medical History Questionnaire
You may fill out this form in advance of your visit to save time at check in. This form is required on your first visit to Buckhead Internal Medicine.