Patient Forms & Insurance

In order to help our team prepare for your office visit, please complete the following forms and bring them to your next appointment. This will help to streamline the check-in process and ensure our files are up-to-date. If you have any questions, please feel free to contact your Piedmont Physician's office.

pdf icon Medical History Form pdf icon Consent to Treat pdf icon Patient Registration pdf icon Medicare Questionnaire pdf icon Billing & Financial Policy pdf icon Notice of Privacy Practices pdf icon Medicare Health Risk Assessment pdf icon Routine Assessment of Patient pdf icon Georgia Advance Directive

For more information about Piedmont Physicians, read our brochure.

 

Insurance Information

We accept most major insurance plans. If you do not see your plan below or have a question about your specific plan, please call your physician's office or call your insurance company.

NAME OF PLAN TYPE OF PLAN
Aetna HMO/POS/PPO/Open Access
Beech Street PPO
Blue Cross Blue Shield of Georgia HMO/POS/PPO/Open Access
CIGNA Healthcare of Georgia HMO/POS/PPO/Open Access
Coventry Healthcare of Georgia HMO
Coventry National HMO/POS
Evolutions PPO
First Health PPO
1st Medical Network PPO
Great West HMO/POS/PPO/Open Access
Highway to Health PPO
Humana HMO/POS/PPO/Open Access
Kaiser HMO (limited to small network of physicians) HMO
Kaiser POS POS
LifeWell EPO/POS/PPO
NovaNet PPO
Private Healthcare Systems (PHCS) (NOT Multiplan) PPO
Tricare HMO
United Healthcare HMO/POS/PPO/Open Access