Forms

Our goal is to make the most of the time you have scheduled with Dr. Scott.  We are dedicating ourselves to making your visit as hassle free and timely as possible.  To do this we need your help!  To save time at check-in, please complete the forms below before your NEW PATIENT visit or ANNUAL EXAM.  Send the Medical Record Release Form to your former provider's office before your first visit to our new practice.  Fax or mail the other forms to our office.  If you cannot do this before your appointment, no worries.  Just bring the forms with you.  Our fax number is 678-264-0939.

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Medical Record Release Form If you want to authorize the release of your medical records from your existing health care provider to us or someone other than yourself, please print and complete this form, and bring it with you to our office, or fax it to us at 678-264-0939.  If you cannot take care of this before your appointment, no problem.  Just come at the scheduled time anyway!  Click here to download Patient Registration Form Once your appointment is confirmed, please print and complete this form.  Bring it with you to our office, or fax it to us at 678-264-0939.  Click here to download Medical Health Questionnaire (New Patient) For your first visit to Scott Gynecology & Pelvic Surgery, please print and complete this form even if you have seen Dr. Scott before.  Fax or mail to us before your visit if possible. You can also bring it with you to our office.  At this time do NOT email this form to us.  Our fax number is 678-264-0939.  Click here to download HIPAA Consent Form  By signing on this form, you agree to the use and disclosure of your health information for treatment purposes, payment activities and healthcare operations of our office.  Your personal information is always confidential.   Click here to download    Click here to download    Click here to download