Patient Forms & Resources

The physicians and staff at Alpharetta and Cumming Internal Medicine welcome you as a new or returning patient. For your convenience, please print and fill out all applicable forms and present them to the front desk when you arrive for your office visit.

At Alpharetta and Cumming Internal Medicine, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to download and complete the forms. Click here to download AdobeReader®.
  • Click on the links below to open and print out the form(s).
  • Complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment. Our Fax number is 770-442-0193.

Patient Forms

Notice of Privacy Practices

Authorization to Release Information

Consent to Discuss Medical Information

Patient Acknowledgement

Referral Form and Information

Procedural Forms

Annual Physical Form (English)

Annual Physical Form (Spanish)

Thallium Stress Test Instructions

Bone Density Questionnaire (English)

Bone Density Questionnaire (Spanish)

The portal is a convenient way to leave non urgent messages for the staff to communicate with your MD, the business office or our advocates. It is monitored during business hours on Monday thru Friday from 9AM to 4PM. It is not monitored on the weekends. Please call the office for any urgent concerns.