Appointment Request

Please use the form below to request an appointment. Someone from our scheduling team will reach out to confirm your request and finalize your appointment.

**Please note - filling this form out does not create an appointment in our system. Due to the volume of patients we see, we cannot guarantee your requested time will be available. If this is an emergency, or you'd like to schedule an appointment over the phone, please contact our office.

Patient Information
Patient Name*
First Last
Email Address*
Date of Birth*
MM slash DD slash YYYY
Phone Number*
Are you a new patient?*
- Yes
- No
Appointment Information
Problem/Reason for Appointment*
Which office would you like to visit?*
Has your insurance changed since your last visit?*
- Yes
- No
Preferred Time*
Preferred Date*
MM slash DD slash YYYY
Communication Consent*
I understand that Georgia Nephrology cannot guarantee privacy for e-mail communications over the internet, other than website submissions from their official website, www.ganephrology.com. I understand and accept this risk, and thus, will allow Georgia Nephrology to communicate my protected health information using my personal e-mail address listed above.
Comments
This field is for validation purposes and should be left unchanged.

Appointment Request

Patient Information

Appointment Information