Patient Resources

Patient Forms

If you are a new patient to our practice please print and fill out the forms below and bring with you to your first appointment. Each patient should complete the new patient demographics form along with a medical history form. Please note there are different medical history forms depending on your type of visit. Remember to bring a photo identification card and your insurance card(s) with you to every visit, along with a list of current medications you are taking.

Form Name Link
New Patient Demographics Download
New Patient Medical History For Cardiology Services Download
New Patient Medical History For Vascular Services Download

Miscellaneous Forms

Form Name Link
Medical Record Release Download
Forms Completion Download
Consent Forms Download

Do You Need an Interpreter?

Form Name Link
Interpreter Services Download

Office Procedure Instructions

Form Name Link
Carotid, Vascular, Abdominal Ultrasound Download
Echocardiogram Download
Event Monitor Download
Holter Monitor Download
Nuclear Stress Test Download
Treadmill Stress Test Download
Vein Ablation Download

Dr. Gupta’s Electrophysiology Procedures

Form Name Link
Pacemaker Implant Instructions Download
NIPS Intructions Download
EP Study/Ablation Instructions Download
Bi-V Implant Instructions Download

Vein Clinic Forms

Form Name Link
Consent Form Download

Education

Lifestyle & Risk Reduction
NAME LINK
African Americans and High BP Download
Cooking Healthy Download
Eating Out Download
Healthy Eating Download
High Blood Pressure Reduction Download
Losing Weight Download
Lowering Cholesterol Download
Low Salt Diet Download
Make Recipes Healthy Download
Monitoring Cholesterol, Blood Pressure,
and Weight
Download
Physical Activity Download
Physically Active for Life Download
Reading Food Labels Download
Smoking Cessation Download
Smoking Cessation and Stress Download
Smoking Cessation and Weight Gain Download
Understanding Food Nutrition Labels Download

Billing

Billing Contact Number – 770/692-4000

Insurance Information

Our practice understands how complicated insurance issues can be to our patients. Please take note of the following:

  1. As a courtesy we will file insurance claims on your behalf.
  2. Please have your most current insurance information with you when visiting our office
  3. Please be aware that each insurance company has specialized plans, often tailored to specific organizations. Most insurance companies give our Billing Staff access to insurance company websites for general patient information. Such information is not always correct nor is it always current. It is the responsibility of each patient to verify their coverage with their insurance company.
  4. Please be aware that there may be times that insurance companies will certify procedures on the phone or on paper but will withhold payment at the time of the processing of the claim for a variety of reasons. Our Billing Staff is only as good as the information we receive and we have no control over how a given insurance company will process a claim. For that reason, we are not responsible for unpaid balances which might occur due to insurance company decisions, even if we received a pre certification prior to a given procedure. PRIOR AUTHORIZATION DOES NOT GUARANTEE PAYMENT.
  5. Please note, most HMO/managed care plans require a referral from your Primary Care Physician to provide benefit coverage for specialist services prior to the actual office visit. It is the patient’s responsibility to obtain a referral prior to your appointment. Your appointment may be rescheduled if a referral is not available at the time of your appointment.
  6. Waiving co-payments, coinsurance, or deductibles is a violation of our contract with our insurance carriers. For that reason, co-payments and balances are due at the time of service. For your convenience we accept credit/debit Visa, MasterCard, American Express, Discover as well as cash and checks.

If your insurance provider is not listed below, please call the phone number on your insurance card and ask if our practice is contracted with your insurance plan.

Our insurance plan participation includes, but is not limited to, the following carriers:

NAME OF PLAN PLAN TYPE
Aetna HMO/POS/PPO
Assurant PPO
Blue Cross/Blue Shield of Georgia HMO/POS/PPO
CIGNA Healthcare HMO/POS/PPO
Coventry Healthcare HMO/POS
Great West PPO
Humana HMO/POS/PPO
Kaiser MultiChoice Plan
Medicaid and Medicaid Replacement Plans All
Medicare All
Medicare Replacement Plans All
PHCS POS/PPO
Southcare/First Health PPO
Tricare Prime, Standard
United Healthcare Open Access
Workers Compensation All

FAQ

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