Patient Forms


Physician Article

Patient Forms


The following forms are available on our website to expedite your check-in at the time of your first appointment. Please take a moment before your appointment to print out and complete the forms below. They may be mailed to our office at West Georgia Physicians Gastroenterology, 1551 Doctors Drive, LaGrange, GA 30240. We can then enter your information into our sytem prior to your visit and minimize your wait time. Alternatively, if there is not sufficient time for your forms to reach us in the mail, you may print and complete the forms and bring them with you at the time of your visit.

If you are a registered patient portal user we have automated the completion of these forms that will save you a great deal of time and effort. 

Click on the links below to open the forms in Adobe PDF format. To print your form, click on the printer icon in the new window. To return to this page, simply close the window.

PATIENT ACKNOWLEDGEMENT OF NOTICE OF PRIVACY PRACTICES - Our Privacy Policy is available on this website. After reading this information, please complete and sign the Acknowledgement form.

Patients Referred by Other Physicians
Many of our patients are referred by their primary physician for special evaluation and treatment. These patients should bring their medications, medical records, and insurance information with them on their first visit. Our doctors work closely with referring physicians. Some referred patients may be seen for long-term or follow-up care; however, the referring physician remains the patient's primary physician.