For Your Convenience ...
Forms
PTP Referral Form (English) or, use our secure online Referral Form.
PTP Informed Consent (English), or use our secure online informed consent form (includes Informed Consent and Health Screen).
PTP Informed Consent (Spanish).
PTP Authorization to Release/Receive Information (English), or use a secure online authorization to release/receive information form.
PTP Authorization to Release/Receive Information (Spanish), or use a secure online authorization to release/receive information form in Spanish.
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 our secure online Referral Form.
PTP Informed Consent (English), or use our secure online informed consent form (includes Informed Consent and Health Screen).
PTP Informed Consent (Spanish).
PTP Authorization to Release/Receive Information (English), or use a secure online authorization to release/receive information form.
PTP Authorization to Release/Receive Information (Spanish), or use a secure online authorization to release/receive information form in Spanish.
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.
