Request an Appointment

Please fill out the details in the form below to submit a new appointment request for Suburban Hematology Oncology. DISCLAIMER: If you are experiencing a medical emergency please call 911. This form is for appointment requests only.

To request paper copies of medical records please fax 678.771.6143

Our billing department fax number is 678.780.4969

Appointment Request Form

First Name

Last Name

Message

Date of Birth

Race

Gender

Street Address

City

Postal / Zip code

Region/State/Province

Phone

Preferred Language

Patient Status

Existing Patient

New Patient

Insurance Company

Policy ID Number

Referring Physician and Diagnosis

I agree to recieve phone calls and text messages at the above number.

Thanks for submitting!

SMS Terms of Service

Messaging frequency may vary.
Message and data rates may apply.
To opt out at any time, text STOP.
For assistance, text HELP or visit our website at gwinnettcancercare.com.

By opting into SMS from a web form or other medium, you are agreeing to receive SMS messages from NSH Cancer Institute. This includes SMS messages for appointment scheduling, appointment reminders, post-visit instructions, lab notifications, and billing notifications. Message frequency varies. Message and data rates may apply. See privacy policy below. Message HELP for help. Reply STOP to any message to opt out.

Request an Appointment

Appointment Request Form

Thanks for submitting!

Consent to Communicate

HIPAA Privacy Policy