Skip to Main Content
NWGA Specialty Care Clinic
DPH logo Contact
  • About Us
  • HIV
  • Linkage to Care
  • Services
  • Eligibility
  • Patient Forms
  • FAQ
Contact
  • About Us
  • HIV
  • Linkage to Care
  • Services
  • Eligibility
  • Patient Forms
  • FAQ

Patient Forms

Below you can find several of our forms you can fill out and bring in to their your appointment. These can be printed off and filled out, then you can either fax, email, mail, or physically bring them to the clinic.

  • Client Agreement
  • Client Intake Form
  • HIPAA Form
  • Housing Application
  • Income Eligibility
  • New Client History
  • Partner Notification Form
  • Release of Information
  • Statement of Support
  • Vision Application

Contact

16 East 12th Street
Suite 202
Rome, Georgia 30161 706-295-6701

NWGA Public Health

Hours

Monday 8am - 5pm
Tuesday 8am- 6pm
Wednesday-Thursday 8am - 5pm
Friday 8am - 2pm

© 2025 NWGA Specialty Care Clinic. All rights reserved. Made by Romega Digital