Contact A Patient
Northeast Georgia Medical Center
Date
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Your Name
*
Your Phone Number
*
Your E-mail Address
example@example.com
Patient Name
*
Room Number
Message
*
I acknowledge that I am submitting my personal information to NGHS, which will be used in accordance to our Online Patient Privacy Policy.
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I agree
View the NGHS Online Patient Privacy Statement
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