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Cartersville Surgical Associates, PC
970 Joe Frank Harris Parkway
Cartersville, GA 30120

Phone: 770.386.1261
Fax: 770.386.3873
We understand that filling out a bunch of paperwork for healthcare in today's world is no fun. We've made every effort possible to minimize the paperwork required for our patients, while also getting the necessary information we need to provide you with the highest quality service possible.

The Following Forms Are Included:

  1. Patient Consent for Treatment
  2. Patient Medical History Form 1
  3. Patient Medical History Form 2
  4. HIPAA Consent for Treatment, Payment and Operations
  5. Patient Request for Personal Medical Records
  6. Patient Request for Medical Records Production to Third Party

Please Note: Adobe Acrobat Reader is required to view the registration forms. You can download a free version of Adobe's Acrobat Reader by clicking here.