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Forms for New Patients

Save time by downloading our New Patient Forms before your first visit. (Updated March, 2017)

For Patients: Please click here for Request for Medical Records Form (Updated Dec, 2015)

Please print, complete and bring to our office.

If you are a bariatric patient of Dr. Daly please download his Medical History Form

Our forms use Adobe Reader. Don't have it? Get Adobe Reader

Many of our procedures require the use of another Surgeon and or a Physician Assistant. Please download, print, complete and bring the following form to our office. Physician Assistant Form

North Atlanta Surgical Associates does not discriminate on the basis of race, color, national origin, age, disability, sex, or sexual orientation. North Atlanta Surgical Associates does not exclude people or treat them differently because of race, color, national origin, age, disability, sex or sexual orientation.

If for some reason you have a comment or concern regarding any of the mentioned above please call 678-387-2945. Comments or Concerns can also be E-Mailed to complianceconcerns@nasasurgeryatl.com

Insurance Information for Patients

Online Bill Pay

Our Physicians currently accept:

  • Aetna
  • BeechStreet
  • BCBS “ We do not accept any BCBS Pathway products”
  • Cigna
  • Cigna Healthspring
  • Coventry
  • 1st Medical Network SUPERMED
  • Great West
  • Humana
  • Humana Medicare Advantage
  • Humana Choice Care Network
  • Private Healthcare Systems
  • Medicare
  • Railraod Medicare
  • United Healthcare
  • Tricare and Tricare Prime
  • Employers Health
  • Perdue
  • Piedmont Wellstar
  • VA/VA Champus-Patient must have referral/pre-authorization

EXCHANGE PRODUCTS

NOT PARTICIPATING:

  • BCBS PATHWAY
  • KAISER
  • PEACH STATE/AMBETTER
  • ALLIANT

PARTICIPATING:

  • HUMANA HMOX
  • COVENTRY ONE
  • CIGNA
  • HARKEN HEALTH
  • UHC COMPASS-referral required

NASA DOES NOT PARTICPATE WITH WELLCARE MEDICARE PRODUCTS. WELLCARE IS ALSO THE NAME OF A MEDICAID PRODUCT. WE DO NOT PARTICPATE. 

IF YOUR INSURANCE IS NOT LISTED ABOVE PLEASE CONTACT ONE OF OUR OFFICES.

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