Now accepting Telehealth appointments. Schedule a virtual visit.

Patient Intake


Please email the answers to the following intake questions to prior to your appointment: 

Full Name:

Preferred Salutation: 


Date Of Birth: 

Mailing Address: 

Email Address: 

Mobile Number: 

Emergency Contact: 

Drug Allergies: 

Current Medications: 

Medical History (ex. High Blood Pressure): 

Primary Care Doctor: 

Reason For Visit: 

Email for Payment: 


Contact our office if you have any questions! 

What we offer


iClinic Atlanta
2531 Briarcliff Rd., Suite 211
Atlanta, GA 30329
Phone: 678-274-6696
Office Hours

Get in touch