Please email the answers to the following intake questions to iclinicatlanta@gmail.com prior to your appointment:
Full Name:
Preferred Salutation:
Pronouns:
Date Of Birth:
Mailing Address:
Email Address:
Mobile Number:
Emergency Contact:
Drug Allergies:
Current Medications:
Medical History (ex. High Blood Pressure):
Primary Care Doctor:
Reason For Visit:
Email for Payment:
