Forms

To save time, you can print and fill out the appropriate forms prior to your visit with us. If you are unable to print beforehand, we can provide you forms to fill out prior to being seen.

If you are a new patient, please read and fill out these forms prior to your visit.

• New Patient Form
• Patient Responsibility Agreement
• FCMG Financial Policy
• Please be sure to bring all of your medication bottles with you to your appointment
• If you are coming from outside of Georgia, please bring a copy of your immunization record.

If you previously saw or are currently seeing another doctor or specialist, please fill out a medical release form so that we can get records from them. Fill one form for each doctor:

• Medical Release Forms

If you or your child is getting an annual wellness health check, please complete the appropriate form prior to being seen. Select form by age:

• 3-5 Day (or first week)
• 1 Month
• 2 Month
• 4 Month
• 6 Month
• 9 Month
• 12 Month
• 15 Month
• 18 Month
• 24 Month
• 30 Month
• 3 Year
• 4 Year
• 5 Year
• 6 Year
• 7 Year
• 8 Year
• 9 Year
• 10 Year
• 11 Year
• 12 Year
• 13 Year
• 14 Year
• 15 Year
• 16 Year
• 17 Year
• 18 Year
• 19 Year
• 20 Year
• 21 Year
• 22-64 Year
• >65 Year