For Your Convenience ...
Forms
PTP Referral Form (English) or, use a secure online form.
PTP Informed Consent (English), or use a secure online form (includes Informed Consent and Health Screen).
PTP Informed Consent (Spanish), or use a secure online form.
PTP Authorization to Release/Receive Information (English), or use a secure online form.
PTP Authorization to Release/Receive Information (Spanish), or use a secure online form.
PTP Medical Records Request Form (English) or, use a secure online form.
Brochures
PTP Short Brochure (English)
PTP Short Brochure (Spanish)
PTP Full Brochure (English)
Georgia Medicaid Applications
Georgia Medicaid Eligibility & Application Instructions
Georgia Medicaid Application (English)
Georgia Medicaid Application (Spanish)
**IMPORTANT**
Fillable forms must be downloaded and saved to your computer before entering your information. We recommend opening and completing form files using Adobe Acrobat Reader DC.
PTP Referral Form (English) or, use a secure online form.
PTP Informed Consent (English), or use a secure online form (includes Informed Consent and Health Screen).
PTP Informed Consent (Spanish), or use a secure online form.
PTP Authorization to Release/Receive Information (English), or use a secure online form.
PTP Authorization to Release/Receive Information (Spanish), or use a secure online form.
PTP Medical Records Request Form (English) or, use a secure online form.
Brochures
PTP Short Brochure (English)
PTP Short Brochure (Spanish)
PTP Full Brochure (English)
Georgia Medicaid Applications
Georgia Medicaid Eligibility & Application Instructions
Georgia Medicaid Application (English)
Georgia Medicaid Application (Spanish)
**IMPORTANT**
Fillable forms must be downloaded and saved to your computer before entering your information. We recommend opening and completing form files using Adobe Acrobat Reader DC.
