Patient Forms

In this section, you will find the forms required for your care.
Please download and complete them in advance, and bring them with you to your appointment or submit them as instructed.

Completing these forms ahead of time helps us provide you with more efficient and personalized care.

To download the document click on View Document/ File/ Download/ PDF.

New Patient Package

Complete your demographic information and bring this document at your appointment time.

View Document

Release form for Medical Records

Please fill out this form before submitting a medical records request.

View Document

Update Information

Keep your information up to date and avoid billing issues due to missing/ incorrect information.

View Document

Physicians Referring Patients

Please download and fill out this form with the required information, send it back via fax.

View Document

Medical Records Request

Please verify the information required to request medical records.

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As a patient, it’s your right to get copies of most medical records. Your medical record includes your health history, allergies, medicines, test results, and how to contact you. So, it’s our job to protect your privacy while giving you timely access when you need it.

Request Medical Records

Records and lab results are stored electronically. The state of Georgia regulates how much we can charge per page to cover the costs of labor, time, and resources needed to prepare your request.

Interamerican Diabetes & Endocrinology complies with state and federal regulations related to the release of medical record information.

There are a number of ways to request medical records.

USE OUR PATIENT PORTAL

You can request copies of your medical records and lab results online.
Just log in into the patient portal using your name, DoB and contact information.

1. Enter the patient portal link
2. Log in using mobile phone

3. Click on Dashboard you will see your latest Lab Results.

4. Click on Medical Records / Visit summary
5. On Visit Details column select Visit Summary

6. Download as PDF or print as needed

Call (706)507-7067 for assistance with Patient Portal.

IN PERSON

You may also request your medical records and lab results in person, by mail, or by fax.

To do so, please complete, sign, and date the Medical Records Release Form and submit it to the front desk for processing.

BY FAX

Fax a copy of your driver’s license or state-issued photo ID and the completed release form to (706) 221-3179

After we process the request, we’ll send you an invoice.
Costs vary based on the number of pages released and the records requested.

Once the invoice is paid, you will receive a copy of the records requested.