Patient Resources

Save time at the office by printing our forms online and bringing them to the office with you. To print the forms below you will need Adobe Reader. This is a free program that usually comes on your computer. If you do not have it you can download it by clicking this link – Adobe PDF Reader.


New Patient Forms

New Patient Information Form
Financial Policy
New Patient Privacy Practice Acknowledgement

New and Established Patient Forms

• Pre-Appointment Questionnaire
• Notice of Privacy Practices

Medical Release Forms

• Eagles Landing Family Practice Release to Request Medical Records
• Eagles Landing Family Practice Release to Forward Medical Records
Imaging Center Medical Release Form
• Mammogram Release Form

Medical Records Request
Phone: 678-774-0430  Ext: 5707
Fax #: 678-826-5911

Imaging Center Forms

• Mammogram Packet
• Consent for Mammogram with Implants
• CT Patient History Form
• CT Contrast Consent Form
DEXA Bone Density History Form

Patient Portal Instructions

• Patient Portal