Appointment Request

Welcome to Gwinnett Ob/Gyn Associates where our goal is to provide you services with a lifetime of compassionate healthcare! Our office hours are by appointment only from 7:45am to 4:45pm Monday through Thursday and from 7:45am to 11:45am on Friday. Phone services begin at 8:30am daily.

You may use the form below to send a secure, online appointment request to our practice. This form is for non-emergency appointments only. We will process your request before the end of the next business day. Our office will contact you to confirm your appointment. Your appointment is not scheduled until it is confirmed.

Thank you for choosing Gwinnett Ob/Gyn Associates for your healthcare needs!

Please notify our office within 24 hours if you are unable to keep a scheduled appointment. Failure to notify our office within 24 hours will result in a $25 fee.

Patient Information
Name:
Daytime Phone:
Cell Phone:
Date of Birth:
Address:
City:
State:
Zip Code:
Insurance Information

Please fill out this section completely.

Insurance:
ID Number:
Group Number:
Benefit Verification Phone Number:
Appointment Information
Contact Method: Daytime Phone Cell Phone
Preferred Provider:
   
Preferred Day: Mon.      Tue.      Wed.      Thu.      Fri.
Preferred Time: Morning (AM)    Afternoon (PM)    Any Time (8:00 AM - 11:15 AM) (1:00 PM - 4:00 PM)
   
Secondary Day: Mon.      Tue.      Wed.      Thu.      Fri.
Secondary Time: Morning (AM)    Afternoon (PM)    Any Time (8:00 AM - 11:15 AM) (1:00 PM - 4:00 PM)
   
Type of Appointment:
Explain Other:
How did you hear about us?
Questions:

Office Policies

At Gwinnett Ob/Gyn Associates, we take pride in providing you with healthcare and services in a timely manner. All patients are cared for equally, and the time of your appointment is reserved for you! However, due to the nature of our business, additional needs may cause a provider to run late. We appreciate your patience in these matters. Please arrive on time for your appointment. We reserve the right to reschedule any patient arriving late if we feel it will cause excessive wait time and inconvenience to other patients.

We understand that unforeseen problems may arise preventing you from keeping a scheduled appointment. When possible, please try to give us a 24 hour advance notice of cancellation so that we may offer that time to another patient. Frequently missed appointments are noted and may result in loss of our services.

For your convenience, all patient forms are available in our patient center, and can be printed and completed before your appointment time.

Please discard food and beverages before entering our waiting rooms. There is a deli and seating areas in the lobby downstairs for your convenience.

Please refrain from cell phone usage while in the back office or exam rooms. We respectfully request the ringer be turned off while interacting with office personnel.

We all wish to make your office visit as comfortable and convenient as possible. Thank you for choosing us as your healthcare providers!

Sincerely, the entire staff at Gwinnett Ob/Gyn Associates!