Skip to content

New Patient Paperwork

Welcome to our New Patient Paperwork page.

Gathering information is the first step in our getting to the bottom of your chronic health condition. Based on the reason for your visit, our Patient Care Coordinator Lisa will instruct you on what parts of the paperwork you will be required to fill out and let you know whether you can bring it with you to your appointment or whether the Doctor will need it prior to your appointment.

Please do not come to your initial appointment without the proper paperwork completely filled out. We run a very tight schedule that does not allow time for you to fill out the extensive paperwork needed while you are in the office for your appointment. If you are coming in for a complimentary consult and do not have your paperwork filled out or are late for your appointment you will have to be rescheduled - and that means that you will forfeit your Complimentary Consult and need to pre-pay the normal consultation fee of 49.00 prior to your next appointment. Please understand that the doctor is setting aside 30 minutes of her time to speak to you and respect the time and appointments of our established patients.

Please answer all questions completely on the paperwork. Every question must be answered. If something does not apply to you, please use the numerical value of “0” or write N/A in the space provided. Again, Lisa will instruct you on what paperwork that you will need for your appointment and when we need it. We look forward to seeing you!

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer, Click Here to download.

  • Confidential Patient Information
  • Patient Case History
  • Metabolic Assessment Form (MAF)
  • Neurotransmitter Assessment Form (NTAF)
  • New Patient Questionnaire (NPQ)
  • Neurological Assessment Form (NAF)
  • Consent and Release
  • Records Release

The Metabolic Assessment Form, NTAF Health Questionnaire, and New Patient Questionnaire can be filled out online and then it can be saved on to your computer desktop. Please attach the completed forms to an email message and send them to patient.coordinator@integrativehealthcareofatlanta.com. You may also print completed forms and fax to (678) 804-6450. You will need to print the Neurological Assessment Form, Consent and Release and the Records Release.

Once completed, fax the above forms to (678) 804-6450. You may also scan completed paperwork, attach file to an email and forward to patient.coordinator@integrativehealthcareofatlanta.com.

The Records Release allows us to obtain your previous records. If you have seen a doctor in the last 2-3 years for blood work or diagnostic testing, please include the doctor’s name and phone number so that we may contact them. Please fax this form as soon as possible so that we may get the records we need to evaluate your case properly.

If you do not have access to a printer or fax please call our office at (770) 237-5534 and we will make other arrangements for you.

Thank you,

Lisa Willis

Patient Care Coordinator

Chronic Pain Near Me Dacula GA Special Offer

REQUEST AN
APPOINTMENT

Fill out the form below and a member of our team will contact you shortly.

Schedule Appointment

  • This field is for validation purposes and should be left unchanged.

OFFICE HOURS


Monday
10:00am - 1:00pm
3:00pm - 6:00pm


Tuesday
3:00pm - 6:00pm


Wednesday
10:00am - 1:00pm
3:00pm - 6:00pm


Thursday
10:00am - 1:00pm
3:00pm - 6:00pm


Friday
Closed


Saturday
Closed

Integrative Healthcare
of Atlanta

1342 Auburn Road #114
Dacula, GA 30019
(770) 237-5534

Scroll To Top