PATIENT FORMS

Below you will find a list of common informational and medical forms. Click on the icon to the left of the document's description to download a printable copy. Completed forms can be brought in at the time of service or can be mailed to the following address:

Chhokar Clinic

2300 Manchester Expressway

Suite 1001

Butler Pavilion

Columbus, GA 31904-6802

You can be assured – we have a commitment to excellence when it comes to the level of care we provide.

New Patient Registration Form - Required for all new patients. This form allows us to register you into our practice as well as provides us with a brief medical history of any problems you may be experiencing. Also attached is a copy of our privacy practices.

NEW PATIENT

MEDICAL RELEASE

Medical Records Release Form - Authorizes us to release your medical records to an individual or another doctor's office.

RELEASE FORM

Financial Policy and Insurance Requirements -Information related to established policies within our practice.

FINANCIAL

FINANCIAL POLICY

DIAGNOSTICS INSTRUCTIONS

CREDIT CARDS

Credit Card Pre-Authorization Form - Required to authorize recurring credit card charges or standard payments to the clinic.

CREDIT CARD

NST Instruction Sheet - Important instructions that must be signed and returned to the clinic prior to any Nuclear Stress Test.

INSTRUCTIONS

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COUMADIN CONSENT

Consent for Warfarin (Coumadin®) Educational Material and Consent Form

CONSENT