Patient Forms

Endocrine Specialists of Georgia LLC,

Dr. Puentes is now accepting New Patients. Please print and fill out new patient forms “link below” to submit at the time of your office appointment. If you do not see your insurance provider listed please ask the attendant to ensure coverage is accepted or arrange alternative payment options. Payment is due upon service. Thank you.

Patient Registration Form

HIPPA Front Sheet

Credit Card Payment Consent Form

Cancellation/ No Show Policy

Medical Records Release Form

Patient Acknowledgment Form

Authorization to Release Information To Family Member

Consent for Release of Information for Treatment, Payment, and Healthcare Operations

After Hours

English & Spanish

For more information or to schedule an appointment please call or Contact Us
Endocrine Specialists of Georgia LLC for Cartersville GA & Metro Atlanta Area.