Patient Information

New Patient Forms

Please download and complete BOTH forms below:

New Patient Registration Forms Patient Medical History/Intake Form

You will need to bring to your first appointment, the following:

  • Completed New Patient Registration Forms
  • Completed Medical History/Intake Forms
  • Medical Insurance card
  • Photo ID

If you are unable to print or need assistance with the forms, we ask that you please arrive at our office 30 minutes prior to your scheduled appointment time.

Existing Patients

If any of the following applies to you, we request that you please download and complete the forms below and bring them with you to your next appointment:

  • Your appointment will be your first one this calendar year
  • You have had a change in address or phone number since your last visit
  • You have had a change in your medical insurance since your last visit
Registration Forms Returning Patient Medical History/Intake Form

Medical Records Release

If you would like a copy of your medical records, please complete the form below or fax it to us at 404-300-2986. Please allow two weeks for this request to be completed.

Medical Records Release Form

Insurance Information

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 University Gynecologic Oncology. Notify the front desk whenever your insurance coverage changes so that the medical staff can accurately maintain your important medical records.

Pay Your Bill Online

Important Information

  • Patients can create an account or go directly to Pay Now
  • Please be ready to enter your Date of Birth in MMDDYY format and the account number as it appears on the statement with the 3 digit database at the end.
  • Example: Statement shows account 111111-XYZ (XYZ = Centricity Database). Enter as 111111XYZ on-line.
  • Continue to follow the on-line prompts to enter credit card information and to have receipt e-mailed.
  • For any questions, please have patients call the Galen Patient Services team at 678-223-7932 or e-mail
Click Here to Pay Your Bill Online

Please note this is not for processing any time of service money that is posted under an NCPY charge, please continue to use your current office processes for those funds.

Cancer Patient Resources

Our Locations

Northside Hospital Cancer Institute