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Please fill out both sides of this form and bring it with you 2025

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The document is a comprehensive patient intake and consent form for Atlanta Gastroenterology Associates (AGA). It includes sections for personal history, financial disclosure, privacy practices, and consent for communication regarding medical information. Patients are instructed to fill out the form prior to their appointment, detailing their medical history, current medications, symptoms, and any previous medical services. The document also outlines AGA's nondiscrimination policies and provides information on patients' rights regarding their protected health information (PHI), including how it may be used or disclosed.

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Please fill out both sides of this form and bring it with you 2025

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