Name of Practice Download and fill out patient forms

Hospital Affiliation

Cartersville Medical Center

For more information contact us at

(770) 975-6540

Our doctors are available to meet your healthcare needs. Review their bios for more information.

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Patient Registration Forms & Privacy Notices


If you are a new patient, you can save time by filling out paperwork before you get here. Please print out the registration forms below, fill them out, and then bring them in when you come for your appointment.

Registration Forms for Acworth Urgent Care

Patient Registration Form

Patient Consent Form

Health History Form

Authorization for Release of Private Health Information (PHI)

Release of Information to Patient Representative

Autorización para el suministro de información

Other Forms

Georgia Sports Physicals Form

Privacy Notices

This privacy notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Notice of Privacy Practices

Aviso Sobre las Practicas de Privacidad

These forms require Adobe Reader. If you do not have Adobe Reader, you may download it free here:

Get Acrobat Reader (this link opens a new browser window).