New Patient Forms

Please print out and complete ALL forms listed below.

Additionally, please bring your current insurance card and a photo ID to your first appointment.

New Patient Registration Forms

New Patient Intake Forms

Consent to Communicate

Existing Patient Forms

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

Existing Patient Registration Packet

Optional Forms

If you would like a copy of your medical records, please complete the form below or fax it to us at 404-365-6501. Please allow two weeks for this request to be completed.

Medical Records Release

Associated Brochure Downloads for Your Reference

Patient Rights and Responsibilities Spanish

HIPAA Notice of Privacy Practices Spanish

Partnership for Safety Spanish


We accept most major health insurance plans, however it is your responsibility to contact your insurance carrier to verify coverage and benefits. Patients may be held financially responsible for payment of services should the insurance company deny responsibility. Be sure to bring your insurance card with you every time you visit Primary Care of Brookhaven. Notify the front desk whenever your insurance coverage changes so that the medical staff can accurately maintain your important medical records.


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

Our Location

Primary Care of Brookhaven
4062 Peachtree Road NE
Suite C
Brookhaven, GA 30319
404-365-6500 Get Directions Primary Care