We at Piedmont Urgent Care by WellStreet want to make your visit the best experience possible. If you are new and visiting for the first time, cut down on wait time and the registration process by printing the Patient Registration Form below and filling it out prior to visiting one of our locations. This will allow our staff to provide faster service to get you feeling better and well on your way.
If you are visiting one of our metro Atlanta locations for a sports physical examination, please print and complete the GHSA Sports Physical Form prior to your arrival.
If you have any questions about our Patient Registration Form or GHSA Sports Physical Form, please do not hesitate to contact us at one of our convenient locations!
Patient Form Links
Medical Records Request Form >
(this links to our secure Patient Request Wizard)
Employer’s Authorization for Examination and/or Treatment >
(this links to our secure form platform, CognitoForms.com)
Attorneys & Insurance Companies
Attorney and Insurance Company Request for medical records follow the steps below:
1. Fax your request to Ciox Health – 678-389-4961
Attorney and Insurance companies may follow up with Ciox Health
2. Customer Service for medical records dept. – 770-810-8857