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Bianco Primary Care
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CONTACT US

12315 Crabapple Road Suite 108 Alpharetta GA 30004 Phone: 678-254-2333 Fax: 678-254-2332

Emails:

Dr. Michael Bianco D.O drmike@biancoprimarycare.com
Dr. Shelley Bianco D.O. drshelley@biancoprimarycare.com
Eileen Smith, Membership/Office Mgmt eileen@biancoprimarycare.com 
Kayla Ray, MA kayla@biancoprimarycare.com
Refills refills@biancoprimarycare.com

PATIENT FORMS PACKAGE

Intake Questionnaires

  • New Patient Health Questionnaire
  • Patient Demographic Information
  • Existing Patient Health Questionnaire

Consent Forms

  • New Payment Selection Form
  • AUTHORIZATION TO RELEASE HEALTHCARE INFORMATION
  • ELECTRONIC COMMUNICATIONS AGREEMENT FOR PERSONAL HEALTH INFORMATION
  • Notice of Privacy Practices Acknowledgement
  • Private Medical Practice Agreement
  • New Laboratory Policy and Information
 
 

12315 Crabapple Road
Suite 108
Alpharetta GA 30004
678-254-2333

The Way Healthcare Used to Be.


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@2019 Bianco Primary Care
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GIVE US A CALL: 678-254-2333