Accessible care for everyone
As a non-profit organization, our doors are open to all women and men with breast cancer, regardless of their ability to pay. We accept most insurances and our financial assistance program helps ensure no one is turned away. Through the support of our donors, corporate partners and grants, we’re able to offer many services at discounted rates or free of charge. Care is provided in-person and virtually to serve patients across Georgia.
Expedite your care
To ensure a quicker, more streamlined patient experience, please fill out the forms below ahead of your scheduled appointment. Afterward, please fax (770-360-9276) or email your insurance information and a copy of your driver’s license (front and back of both cards). One of our staff members will reach out to you shortly upon full completion.
Contact us if you need further assistance with filling out the required forms. All submitted information is secure and confidential.
Patient intake form
Health Insurance Portability and Accountability Act (HIPAA) form
Make a payment
Online billing offers patients an easy and convenient way to make a payment in minutes.