Online Forms

Please feel free to call 770.590.7771 or email us to schedule your first appointment


New Patient Health History Form

The Center for Health and Healing offers our patient form(s) online so they can be completed it in the convenience of your own home or office. Thank you for your time. We greatly look forward to meeting you at your first appointment.

New Patient SYMPTOM SURVEY Form Download & Print Form - Required

New Female Patient NRT Form Download & Print Form- Required

New Male Patient NRT Form Download & Print Form- Required

New youth NRT Form Downloads & Print Forms-Required 

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

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999 Whitlock Ave SW
Suite 11

Marietta, GA 30064

Center for Health & Healing

Tel: 770.590.7771

Fax: 770.590.9997

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