Paperwork at Your Fingertips

Prior to your visit, save time by downloadingprinting, and completing all forms below to bring with you. If you aren’t able to access the forms at home, we’ll be happy to provide them and assist you when you arrive.

Required Forms at KCCWC

Patient History Form

Registration Form

HIPAA Privacy Authorization

HIPAA Privacy Compliance

Financial Policy

Prescription Refill Form

Don’t forget to book your appointment

CALL 678-785-5001 to book your appointment
Kingdom Cardiovascular Care and Wellness has multiple locations

MULTIPLE LOCATIONS – DOUGLASVILLE & NEWNAN
8687 HOSPITAL DRIVE, SUITE 102, DOUGLASVILLE, GA 30134
6853 DOUGLAS BLVD STE C, DOUGLASVILLE, GA 30135
1825 HIGHWAY 34 E, STE 3400, NEWNAN, GA 30265