Forms

Please Download, print, and complete the "NEW PATIENT PACKET" and the "MEDICAL HISTORY" forms before your next appointment.

Please fax these forms to our secure fax number 888-747-9242.

ALSO, please bring forms to your first appointment. After insurance authorization is complete, our office will call you to set up a time for first appointment.

At the first appointment, please bring your:

Insurance Card
Government Issued Identification Card(i.e. drivers license)
Payment

Feel free to discuss any questions you might have about our services with the doctor.

NEW PATIENT PACKET

PATIENT HISTORY FORM

As patients of Shailesh Gandhi MD’s practice, please note the following:

–– That Shailesh Gandhi, MD PC is an independent practitioner, renting office space from Kaushik Amin,MD and associates; Georgia Clinic

–– That Shailesh Gandhi, MD PC is not in partnership with Kaushik Amin,MD and associates; Georgia Clinic

–– That Shailesh Gandhi, MD PC have no responsibility for billing of Kaushik Amin,MD and associates; Georgia Clinic

--- That Shailesh Gandhi, MD PC neither control nor supervise the services provided by Kaushik Amin,MD and associates; Georgia Clinic

PHARMACY INFO FORM

PATIENT CARE COMMUNICATION FORM

Forms

SGPC

SG Psychiatry Clinic

770-277-7195

Fax: 888-747-9242