Patient Forms

Use these resources to come prepared for your office visit

Please call Melanoma & Sarcoma Specialists of Georgia office at: 404-851-6000
This line provides a direct access to our office staff and our surgical oncologists, Dr. Kounalakis and Dr. Davidson.

For New Patients

Please click on the links below, print out and complete BOTH the Registration forms AND the Medical Questionnaire below and fax to our office prior to your first appointment at (404) 252-2736. Providing our office with your completed questionnaire prior to your appointment will expedite your care.

If you do not have access to fax or a scanner, please bring your completed forms to your appointment with you.

New Patient Registration Forms
New Patient Medical Questionnaire
Note: *For your convenience, you are able to complete the New Patient Medical Questionnaire using your computer.

In addition to the New Patient Medical Questionnaire, please bring the following items to your first appointment:

  • Insurance card
  • Photo ID
  • Physician referral form (if applicable)
  • Any recent lab work results or tests
    (including any chest x-rays or EKG’s that have been performed in the last year)
  • Medication list, or actual medication bottles
  • Co-pay (if applicable)

For Existing Patients

If any of the following applies to you, we request that you please download and complete the Registration Forms below and bring them with you to your next appointment:

Patient Registration Forms

Download if:

  • Your appointment will be your first one this calendar year
  • You have had a change in address or phone number since your last visit
  • You have had a change in your medical insurance since your last visit

Optional Forms

Medical Records Release

Associated Brochures For Your Reference
(Download not required)

Patient Rights & Responsibilities (Spanish)
HIPAA Notice of Privacy Practices (Spanish)
Partnership for Safety Information Guide (Spanish)
Thank you for choosing Melanoma & Sarcoma Specialist of Georgia. We are committed to providing you with quality healthcare. If you have any questions, please contact our office at 404-851-6000. Our phones are answered Monday through Friday, 8 a.m. to 4:30pm.