Executive Health Pre-Registration

Before your first appointment with a physician from Emory's Executive Health program, you may want to complete the medical history form. (currently not available for download) We also request that you obtain medical records from your other health care providers and bring them with you if possible.

These steps will help us expedite your appointment and assure we have the appropriate information needed to provide the best advice possible during your initial consultation.

Please contact us at 404-778-1234 or email us at: Executive_Health@emoryhealthcare.org to obtain a medical history form.

Complete the form and mail to: Emory Executive Heatlh, 1364 Clifton Road, Atlanta, GA 30322, or you may bring it with you to your first appointment. In order to secure patient confidentiality, we cannot accept the form electronically.