Ph: (770) 386-1000 Home Providers Online Bill Pay Our Practice Patient Information Patient Login Contact/Directions COVID-19 Patient Information Below you will find important information and online medical forms that you can print out before you arrive for your appointment. Patient Forms Please click on and print the forms below. Please fill out the forms and bring them with you to your appointment. This will enable us to expedite your check in process. Thank you for your continued support and we look forward to making your healthcare experience a pleasant one. Patient Information Form Patient Medical History Form Authorization to Release Healthcare Information Form Authorization to Verbally Release Healthcare Information Form Insurance & Fees Our fees are comparable to those charged for similar services in our community. Payment at the time of service is requested to help contain our costs and keep your costs reasonable. Copayments are due at the time of service. For your convenience we do accept both VISA and Master Card. Please be aware that we must have accurate records of your insurance carrier and policy number. You may wish to speak with our billing department to verify whether or not we participate with your particular insurance plan. We are contracted with most insurance plans. Please be aware that if your insurance has not paid your charges within sixty days, these charges will become your responsibility. Please let us know of any changes in your insurance as soon as they occur. In Case of Emergencies If a medical condition arises when our office is closed and you do not feel it can wait until the office reopens, you may reach the on call doctor at (770) 386-1000 at anytime and the answering service will relay your information. Please inform them of your situation and its urgency otherwise you may expect your call to be returned usually within 30 to 45 minutes. Patient Medical Records All information we request from you is needed to provide you with the quality medical services you desire. All the information in your record is confidential and will not be released without your permission. ABOUT US The Family Medicine Clinic of Cartersville Georgia’s mission is to provide personalized, high-quality care on an as-needed or preventative basis. We have created a medical practice that we believe in and choose for our own family, staff and friends. SITEMAP Providers Online Bill pay Our Practice Patient Information Patient Login Contact COVID-19 GENERAL INQUIRIES © Copyright 2021 | The Family Clinic of Cartersville Georgia | All Rights Reserved