Patient Information

New Patient Forms

For patients that wish to complete our paper registration, the following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time you will save significant time at the time of your visit. If you have any questions when filling out these forms, please do the best you can, our staff will assist you with your questions on the day of your visit.

Please printout and complete the appropriate forms:

 Note: The above documents are in Adobe® PDF format. They require Adobe Reader to be viewed. If you do not have Adobe Reader, you can download it for free by clicking here.

Before Your Appointment

  • Check with your insurance company to see if they require a referral.
  • Pre-Register. Click on the Patient Portal link to the right and click the “pre-register” button at the bottom of the page.
  • Fax any pertinent information or reports regarding your visit to (404) 574-5821, including your referring doctor’s notes or colonoscopy/pathology reports that relate to your care.
  • The medication for your intended colonoscopy procedure may be sent to your pharmacy on file with the office prior to scheduling of the appointment. This step is the initial process for proceeding with the procedure. Please collect the medication and wait for additional instructions from the office staff. It is imperative you read the communication and instructions for use of the prep medication at least one week in advance of the procedure.

Patient Portal

Streamline your care with the use of the ATL Colorectal Surgery Patient Portal. Registration is easy and can be started by clicking the Patient Portal link on the right. You will be sent a unique user name and password after completing the initial registration. The Patient Portal is a convenient and secure method to communicate with our office to request appointments, gather information, request records, and make payments.

What to Expect on Your First Visit

  • Bring any medical information or reports relating to your care with you if you are unable to fax it.
  • You will be asked personal information about your medical and family history.  We encourage you to fill out the patient history form. You can download it by clicking the link above or enter it through the patient portal.
  • Make a list of all your medications including their dosages and bring it with you to your appointment.
  • Make a list of your allergies and bring it with you to your appointment or enter it on the patient portal.
  • We will ask you for your preferred pharmacy information.  We will enter your pharmacy name, address and phone number in your electronic health record.  This will enable us to send prescriptions for you directly to your pharmacy.
  • Bring your insurance card(s), personal identification card and a means of payment if you have a co-pay. Payment is expected during the check-in process. We accept Cash, Check, Visa, Mastercard, Discover and American Express. For your convenience, you may also call our business office to pay by phone (404) 574-5820 or mail your payment to our office. Address the check to ATL Colorectal Surgery, and mail to 95 Collier Rd. NW, Suite 4025, Atlanta, GA 30309.
  • During the initial visit with your colon and rectal surgeon, a procedure known as an anoscopy, will likely be performed. The procedure is necessary to evaluate, diagnose as well as treat you for symptoms you may be experiencing. Your insurance carrier may define the procedure as a surgical procedure, which will be applied toward your deductible.
  • Cancellation policy notice: Office appointment must be cancelled 2 (two) business days prior to the scheduled appointment to prevent a late cancellation fee of $30.00. In-office procedures must be cancelled 2 (two) business days prior to the scheduled appointment to prevent a late cancellation fee of $75.00. Surgical procedures must be cancelled 5 (five) business days prior to the scheduled appointment to prevent a late cancellation fee of $200.00. Cancellation fees must be paid in-advance of rescheduling a missed appointment. To cancel any appointment made with the office, you must contact the office at 404-574-5820 to speak with a representative. Do not cancel with the hospital as this does not cancel the appointment scheduled with your surgeon, and any missed appointment will incur a late cancellation fee.

Dr. Joseph Mareno

Dr. Evan Feldman

Dr. Swetha Ramakrishnan