Please review these Frequently Asked Questions to better understand how our clinic works and what we expect from you:
Please print and complete the form or forms below which are appropriate for you, and fax them to Good Samaritan Gwinnett or bring them with you to your appointment. You may fax any form to 678-280-6635.
New Patients: New patients must complete the Patient Information and Medical History forms before seeing a medical provider.
In addition to these forms, you are required to bring the following:
1. Proof of Income (check stub, tax return, unemployment letter, etc.)
2. Photo ID (driver’s license, passport, student ID, etc.)
3. All prescription medications you may be taking
4. If you do not speak fluent English, you must provide your own interpreter
Please arrive fasting (no food or liquids other than water after midnight the night before your appointment) if you are being seen in the morning for an annual physical.
There is a minimum fee of $20 for all blood work; some tests are more expensive.
Established Patients: If your health information has changed since your last visit to Good Samaritan, please complete the following form and bring it to your next visit.
Medication Refills: Print and complete the appropriate medical refill request form below and fax it to 678-280-6635. You must complete the entire form in order to receive a refill. Your refill request must be provided to Good Samaritan Gwinnett no less than two weeks before you run out of medication.
Patient Policies: Our Patient Policies are provided for your review.