Welcome to alpharettaperio.com
Patient Information
Our first concern is our patients. This page has general information and links to various forms you might need. You will find printable patient materials on a variety of topics. Click the contact button if you have additional questions.
We are here to help you!
Your First Visit
Below are the forms that a first time patient should fill out prior to their first appointment.
- Medical History Form (Adult) – We also need a current medical history on file.
- Medical History Form (Child) – We also need a current medical history on file.
- Financial Policy – our Financial Policy consent form.
- Consent Form – Signature Required – please print, fill out and sign this form.
- Health Information Consent Form – consent for use and disclosure of Health Information.
Scheduling
To schedule an appointment, please call 770-410-7565.
We try to adhere to the appointment schedule, but emergencies can cause delays.
If you must cancel an appointment, we request that you give us 48-hour notice.
Privacy Policy
The Notice of Privacy Practices presents the information that federal law requires us to provide to our patients regarding our privacy practices.
Please read the notice and then fill out the Health Information Consent form.
This notice consent form is a pdf document which requires Adobe Acrobat Reader software. Most computers will already have this software loaded. If you have problems reading the notice, please download and install the Adobe Acrobat Reader software.
Financial Policy / Insurance / Care Credit
We share your concern about the increasing costs of providing health care. Our fees are usual and customary for this area.
A major cause of increased health care costs is the expense of preparing statements, mailing and bookkeeping. In order to keep costs as low as possible, payment is expected at the time services are rendered. We are happy to file to your insurance and have payment submitted to you.
- Financial Policy – our Financial Policy consent form.

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