Dr. Mitch Ergas offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

NUTRITION NEW CLIENT FORMS - Required

Nutrition New Client Forms

Nutrition New Client Orientation



COUNSELING NEW CLIENT FORMS - Required

Counseling New Client Information Form (Required)

Counseling New Client Consent Form Part 1 (Required)

Counseling New Client Consent Form Part 2 (Required)

HIPAA Privacy Practices (Required)

Counseling Consent & Authorization To Release Information Form

Informed Consent - Minor Child

Client Information - Minor


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

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Contact

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Dr. Mitch Ergas
2840 Johnson Ferry Road, Ste 300
Marietta, GA 30062
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Office Hours

DayMorningAfternoon
Monday11:00am7:00pm
Tuesday11:00am7:00pm
Wednesday11:00am7:00pm
Thursday11:00am7:00pm
Friday11:00am7:00pm
SaturdayClosedClosed
SundayClosedClosed

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