Registration Forms

PATIENT REGISTRATION FORMS

For your convenience, you may download and print the following Patient Registration Forms for your appointment type, and fax or mail to our office prior to your appointment date. Please remember to include a copy of the front and back of your insurance card along with your completed paper work.

When mailing, we ask that you allow at least seven business days prior to your appointment.

Our office address:

Douglas Women’s Center, PC
880 Crestmark Drive, Suite 200
Lithia Springs, GA 30122

Our fax number: 770-739-6006

Receiving your paperwork early will allow us to update our records before you arrive, minimizing your wait time. If you are unable to mail your information and do not have access to a fax machine, we ask that you please bring the completed forms with you and arrive 10 minutes early on the day you are scheduled to be seen.

Patient Forms:

• Mammogram Registration
• DEXA Bone Density Screening Patient Questionnaire
• Current Patient GYN Care Registration
• New Patient GYN Care Registration
• Current Patients New OB Registration
• New Patient New OB Registration