Forms Patient Forms

To help ensure that your patient information is accurate, please complete the appropriate patient forms on your computer, print, fill out and bring them to your appointment with us. If you are a new patient you will only need to download the new patient form package below. You may also print these forms and complete by hand. Please call us for any questions.

If you have any questions regarding these forms please call the office at (770) 924-9656.

New Patient Forms

Please click on the links below, print out and complete the ALL of the forms below. Additionally, please bring your current insurance card and a photo ID to your first appointment.

New Patient Registration Packet
Medication Record
Patient Information

Existing Patient Forms

If this is your first visit in the new calendar year, you have had a change of address or changes to your insurance since your last visit, please complete the packet below and bring it with you to your appointment so that we can update your medical records.

Existing Patient Forms

Optional Forms

Medical Records Release

Additional Resources

Patient Rights and Responsibilities (Spanish)
HIPAA Notice of Privacy Practices (Spanish)
Partnership for Safety (Spanish)


We accept most major health insurance plans, however it is your responsibility to contact your insurance carrier to verify coverage and benefits. Patients may be held financially responsible for payment of services should the insurance company deny responsibility. Be sure to bring your insurance card with you every time you visit Northside Cherokee Surgical Associates. Notify the front desk whenever your insurance coverage changes so that the medical staff can accurately maintain your important medical records.