Secure Online Registration

• You can register online using our secure system.
  All necessary forms can be completed once logged in to the registration area.
  
  1) New Patient Appointment/Preliminary Registration Form.
  This form will allow you access to our registration system and allow us to contact you with a new patient appointment.
  
  2) Female Registration.
  We use the female partner's contact, billing and insurance information so please start with this form. (NB. If you are coming to RBA without a female partner please complete the Male Registration instead).
  
  3) Female Medical History.
  Please complete these questions for the female partner.
  
  4) Male Medical History.
  Please complete these questions for the male partner.
  
  If you need to change details or if you forgot your password please go here.
  
  If you require any assistance or if you have any questions about registration please call Mary Viskup 404-459-3515.

• Printable Patient Registration Form
  The printable version of the patient registration form is available for download in Acrobat Reader (.pdf) Format. You can either double click on the link and view it right from your web browser, or you can right click the link, select Save Target As, and save it to your hard drive.
  
  Please fax the form asap to 404-256-6999.
  If you require any assistance or if you have any questions about registration please call Mary Viskup 404-459-3515.