Forms

Atlanta Men’s Clinic Downloadable Forms


To help expedite your first visit to the clinic, our new patient registration forms can be downloaded and completed prior to your initial appointment.


HIPAA NOTICE OF PRIVACY PRACTICES

HIPAA NOTICE OF PRIVACY PRACTICES


MEDICAL HISTORY QUESTIONNAIRE

MEDICALHISTORY QUESTIONNAIRE


RECURRING PAYMENT AUTHORIZATION FORM

RECURRING PAYMENT AUTHORIZATION FORM


FINANCIAL RESPONSIBILITY FORM

FINANCIAL RESPONSIBILITY FORM


CONSENT FOR TESTOSTERONE REPLACEMENT THERAPY

PATIENT CONSENT FOR TESTOSTERONE REPLACEMENT THERAPY


CONSENT FOR TESTOSTERONE PELLET THERAPY

PATIENT CONSENT FOR TESTOSTERONE PELLET THERAPY


AGREEMENT NOT TO USE OTHER TESTOSTERONE SUPPLEMENTATION

AGREEMENT TO NOT USE OTHER TESTOSTERONE SUPPLEMENTATION


PRIVACY PRACTICES PATIENT ACKNOWLEDGEMENT FORM

PRIVACY PRACTICES PATIENT ACKNOWLEDGEMENT FORM


For any questions regarding these forms, please contact our office and we will be glad to assist you.