Please click on the link below, then print out and complete. Additionally, please bring your current insurance card and a photo ID to your first appointment.
If this is your first visit in the new calendar year, you have had a change of address or changes to your insurance since your last visit, please complete the packet below and bring it with you to your appointment so that we can update your medical records.
We accept most major health insurance plans, however it is your responsibility to contact your insurance carrier to verify coverage and benefits. Patients may be held financially responsible for payment of services should the insurance company deny responsibility. Be sure to bring your insurance card with you every time you visit Internal Medicine of East Cobb. Notify the front desk whenever your insurance coverage changes so that the medical staff can accurately maintain your important medical records.
Thank you for choosing online bill pay. You will be leaving our website and will be redirected to a third-party site operated by PatientCo. We contract with a third party vendor for online bill-pay to provide patients with the convenience of paying and managing their statements 24 hours a day, 7 days a week.
By clicking the button below, you will be redirected to a payment page hosted by PatientCo. PatientCo is responsible for processing your payment, as well as the security of your information. Please see their Terms and Conditions for more information. If you are redirected to a site managed by someone other than PatientCo, please leave the site immediately, do not continue with the payment process, and contact our customer service line at 678-223-7932.