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404.814.9808 • fax: 404.814.6086 • admin@centrespringmd.com
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Forms


New patients must complete the forms listed below for the first appointment. These forms can be “fillable” (downloaded, saved, filled out on a computer and returned) or “printable” (downloaded, printed out, filled in by hand and returned).

“Printable” Form Instructions — print out and complete by hand.
1. Download the form file PDF and print it out.
2. Fill in the blanks by hand — please print clearly.
3. Mail or bring to the office; fax the completed form to 770.475.9244; or scan and attach to an email sent to gahormones@gmail.com.

“Fillable” Form Instructions — fill out on computer.

1. Download the form file PDF and “Save Page As…” a new PDF with a file name that includes your name (e.g., “YourName_gh_new_pat_reg_form_090715a.pdf”).
2. Close the new file and then reopen it with Adobe Acrobat Reader (downloadable for free from Adobe.com if needed).
3. Type the information into the form, save (or “save as”), close and then reopen it to make sure the entered information is still there.

4. To return the filled form, either:
  • (a) attach the completed form file to an email sent to gahormones@gmail.com or
  • (b) print the completed form and mail or bring it to the office; or fax it to 770.475.9244; or scan and attach it to an email sent to gahormones@gmail.com.

Patient Information Form
patient_information_form_final.pdf
File Size: 41 kb
File Type: pdf
Download File


New Patient Routine Procedures Form
gh_new_pat_rout_proc_form_090715a.pdf
File Size: 160 kb
File Type: pdf
Download File


New Patient Privacy Practices Notice
Read this HIPAA info, keep a copy for yourself and return a copy signed (on page 3):
privacy_new_8_31_15.pdf
File Size: 130 kb
File Type: pdf
Download File


Receipt of Written Privacy Practice
receipt_of_written_privacy_practice_.pdf
File Size: 93 kb
File Type: pdf
Download File


Patient Financial Responsibility 
patient_financial_responsibility.pdf
File Size: 88 kb
File Type: pdf
Download File

Home
Our Practice
Dr. Robert P. Goldman

Donna Smyth, PA-C
Functional Medicine
Women’s Hormone Health
Menopausal Health
Men’s Hormone Health

Case Studies
Testimonials
Resources for Patients

For Medical Professionals

FAQ
Forms
​Blog
Disclaimer
Privacy
Location/Directions

Contact Us
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Copyright © 2022 Georgia Hormones, PC  •  All Rights Reserved
10220 Medlock Bridge Road  • Johns Creek, GA 30022
phone: 404.814.9808  •  fax: 404.814.6086  •  admin@centrespringmd.com