The DoctorsPlace Medical Weight Loss

Online Forms

Physicians Weightloss and Wellness Center pwlga.com

You may mail or fax the forms in advance of your appointment
via the contact information below.
(770) 431-2322.
email: info@drplaceweightloss.com

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Medical History Form	Word Document (.doc) Adobe Acrobat (pdf)
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Patient Information Form	Word Document (.doc) Adobe Acrobat (pdf)
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Release of Medical Records Form	Word Document (.doc) Adobe Acrobat (pdf)

Physician's Weight Loss and Wellness Center

DoctorsPlace Medical Weight Loss Center
4480 N. Cooper Lake Rd
Suite 220
Smyrna, GA 30082
Phone 770.431.2322
Fax 770.431.2321