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.
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
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
Associated Brochures for your Reference
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
Thank you for choosing online bill pay. You will be leaving our website and will be redirected to a third-party site operated by PatientCo. We contract with a third party vendor for online bill-pay to provide patients with the convenience of paying and managing their statements 24 hours a day, 7 days a week.
By clicking the button below, you will be redirected to a payment page hosted by PatientCo. PatientCo is responsible for processing your payment, as well as the security of your information. Please see their Terms and Conditions for more information. If you are redirected to a site managed by someone other than PatientCo, please leave the site immediately, do not continue with the payment process, and contact our customer service line at (678) 223-7932.
- Create an account or make a payment online by clicking the link below
- If making a payment, please be prepared to enter the SecureHealthCode listed on your statement and the amount due
- Continue to follow the online prompts to enter payment information
- At this time, you may also opt into email and/or text message notifications when a new bill is ready for review and payment
- If you have questions regarding your statement(s), please contact the Galen Patient Services team at (678) 223-7932 or e-mail NSHPatientConcerns@galenadvisors.com