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Forms

New Patient Forms

Please download and complete the New Patient Registration Forms and Medical History Forms and bring them with you to your first appointment along with your medical insurance card and photo ID. If you are unable or need assistance, we ask that you please arrive at our office 30 minutes prior to your scheduled appointment time.

New Patient Registration Form

Medical History Form


Existing Patients

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 form below and bring it with you to your appointment so that we can update your medical records.

Existing Patient Registration


Optional Forms

Medical Records Release


Additional References

[not required for registration or returning patients]

Patient Rights & Responsibilities Spanish

HIPAA Notice of Privacy Practices Spanish

Partnership for Safety Information Guide Spanish

Coronavirus Disease 2019 (COVID-19)

For the latest information about COVID-19, please visit the Centers for Disease Control and Prevention website.

Map and Directions to Our Office

East Cobb Family Medicine
1121 Johnson Ferry Road
Building 2, Suite 100
Marietta, GA 30068
770-509-0017 Get Directions Primary Care Monday: 7:30 a.m. - 4:00 p.m.
Tuesday: 7:30 a.m. - 4:00 p.m.
Wednesday: 7:30 a.m. - 4:00 p.m.
Thursday: 7:30 a.m. - 4:00 p.m.
Friday: 7:30 a.m. - 1:00 p.m.