Click on the link below for a PDF version of the form.

• Acknowledgement of Receipt of Privacy Notice
• Patient Information Form
• Patient Record of Disclosures
• Physician Practice Financial Policy and Release of Information
• H&P Patient Visit Form

Insurance Networks (As of January 1, 2009)

• Blue Cross Blue Shield of Georgia
• United Healthcare of Georgia
• Aetna
• Georgia Medicare Part B - Cahaba GBA
• Georgia Medicaid
• South Carolina Medicare Part B - Palmetto GBA
• South Carolina Medicaid
• Amerigroup
• Memorial Health Plan - (MHP)
• All Medicare Advantage PFFS Plans
• St. Joseph's Candler Health System - The Care Network PPO
• TriCare
• Wellcare Medicare Advantage
• First Health MultiPlan/PHCS
• Cigna Healthcare
• Wellcare Medicaid
• Principal Edge
• Multiplan/PHCS
• Coventry Physicians First Network
• Arcadian/Southeast Community Care

This list is subject to change. If you are unsure if we participate with your insurance company, please ask us.