2001 Peachtree Road NE
Suite 575
Atlanta, GA, 30309
(404) 350-0106

Medical Forms You May Require

New Patient Information & Form

New patient forms are downloadable in Word or PDF format.

MS Word Format Adobe PDF Format
(click on the appropriate icon to download)

New Patient Information Package

Existing Patient Information & Forms

    Acknowledgement of Notice of Privacy Practices
    Authorization to Obtain and Use or Disclose Information
    Medication Contract

Meet Our Physicians

Regis W. Haid, Jr., M.D.

Steven D. Wray, M.D.

Roger H. Frankel, M.D.

David M. Benglis, Jr., M.D.

Spine Surgery in Atlanta.

By using this website, you acknowledge that you have read and agreed to the terms of our legal disclaimer. The information provided is not intended to replace the medical advice of your doctor or health care provider. For additional health information, please contact our office. © 2003-2012 Atlanta Brain and Spine Care, Atlanta, Georgia