February 28, 2021
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Northeast Georgia Diagnostic Clinic

NEW–Oncology/Hematology Patients:
470-228-7700


All Other Specialties:
770-536-9864

Toll Free Number:
1-800-820-6432

Northeast Georgia Diagnostic Clinic

NEW–Oncology/Hematology Patients:
470-228-7700


All Other Specialties:
770-536-9864

Toll Free Number:
1-800-820-6432

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  • Contact Us
MENUMENU
  • Home
  • About Us
    • History
    • Physicians
    • Administrative Staff
  • Providers
    • Physicians
    • Advanced Practice Providers
  • Specialties
    • Internal Medicine
    • Cardiology
    • Endocrinology
    • Oncology/Hematology
    • Nephrology
    • Pulmonary Medicine
    • Rheumatology
  • Services
    • Cardiology Services
      • Nuclear Medicine
    • Clinical Laboratory
    • DirectCare
      • DirectCare FAQS
      • DirectCare Highlights
    • Cancer Care
      • Chemotherapy
      • How Chemotherapy Works
      • Low Dose CT Lung Cancer Screening
    • Diabetes Education
    • Imaging Services
      • Bone Densitometry
      • CT Scans
      • Digital Mammography
      • MRI
      • Nuclear Medicine
      • Ultrasound
      • X-ray
    • Nutrition Services
    • Pharmacy
    • Pre-Op
    • Pulmonary Function Testing
    • Sleep Medicine
      • Sleep Disorders
        • Sleep Apnea Treatment
        • Insomnia Treatment
        • Narcolepsy Treatment
        • Restless Leg Relief
        • Shift Work Sleep Disorder Treatment
        • Tips for Decreasing the Effects of SWSD
        • Snoring Solutions
      • Sleep Study
        • Sleep Study Preparation
        • Sleep Study Forms
  • Patient Information
    • Forms
    • Medical Records Request
    • Radiology Imaging Request
  • Patient Portal
  • Patient Billing
  • Contact Us

Forms


New Patient Forms

Please click on the appropriate link 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 Forms | (Spanish)
  • Internal Medicine Medical History Form
  • Medicare Annual Health Risk Assessment
  • Consent to Communicate | (Spanish)

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 Registration Packet | (Spanish)
  • Medicare Annual Health Risk Assessment
  • Consent to Communicate | (Spanish)

Optional Forms

  • Consent for Telemedicine Services
  • Medicare Secondary Payer Questionnaire
  • Medicare Beneficiaries – Admissions Questionnaire

Medical Records Request Form

Please click here to learn more about requesting your medical records. Be sure to sign, and date the form and provide a complete fax number or address where records need to be sent.
Please allow 5-7 business days for processing

  • Medical Records Request Information (Spanish)

Associated Brochure Downloads for Your Reference

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

 

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News

  • NGDC Physicians Recognized in Georgia Trend Magazine
  • NGDC Voted Best of Hall 2021 in 7 Categories
  • NGDC Healthy Hall Award Winners 2019
  • NGDC Voted Best of Hall 2019 in 12 Categories
  • Accepting Internal Medicine patients at Highpoint Medical Center
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Copyright© 2021 Northside Hospital Inc.
A Northside Hospital Physician Practice.
All Rights Reserved.
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