Forms

Continuity of Care Request

 

We have invested in technology to better serve you. In lieu of registration forms, we ask that you complete registration via our mobile check-in option prior to your visit. This secure process allows us to maintain accurate, up-to-date information and results in faster check-ins. You will receive an email prior to your visit with instructions on completing this process. You may also register electronically upon arrival at our office with the tablets provided.

To request that medical information about you be sent to another physician, your employer or another entity, this form must be completed and signed. This allows Laureate Medical Group to release or obtain protected medical information on your behalf.

Sleep Medicine Questionnaire – Follow-Up Appointments

Sleep Medicine Questionnaire – New Patient Appointments

All new patients of the Sleep Medicine Practice must complete the above questionnaire prior to his/her scheduled appointment.

Voicemail Consent

To ensure the protection of your health information and to remain in compliance with HIPAA regulations, Laureate providers and staff will not leave detailed voicemails for patients containing health information.  If you would like us to leave voicemails for you regarding your sensitive health information, please fill out the below form and submit to your practice location manager

 

Forms Completion Fees

Our practice receives many requests to complete various patient forms such as insurance, disability, FMLA, and handicapped parking. Completion of these forms requires medical expertise and a review of medical record documentation. For this reason, a fee based on complexity and length of the forms will be collected prior to releasing the form. It is the patient's responsibility to complete his/her portion of the form and submit it to the requesting party.

Please refer to the fees indicated for applicable requests. If you mail the form to us, please make sure that you send payment with your request. No forms will be completed prior to payment of fees. 

Fee: $35  

• FMLA
• Disability Forms
• Home Health Forms
• Patient Transportation (MARTA)
• Parking Affidavit/Handicap Form
• Adoption Forms
• Sport Physical Education Forms
• Nursing Home Entrance
• Assisted Living Forms
• Pre-Operative Forms
• Jury Exemptions

Fee: $40  

• Returned Checks (unpaid by your bank)

Medical record requests are priced individually. Please call our Medical Records Department to determine your cost.

Please note:

• Charges are not billable to your insurance provider and are your responsibility. 
• All fees must be paid before your next appointment with one of our providers.