PLEASE READ BEFORE PROCEEDING TO YOUR REGISTRATION INPUT:

The following registration form is for new records review and evaluation cases only. Please do not register if you are an existing CEC patient (current or any year prior) or have (or plan to schedule) an in-office appointment.

If you are an existing CEC patient (from any year) in need of assistance, again, please do not register.
Please call us at 770-913-0001 and we'll be delighted to help you.

If you were looking to book an in-office appointment (fees apply), please note appointments are not made online. Call us at 770-913-0001 and our staff will be delighted to book you and review the costs/insurance aspects with you. Again, please do not complete this registration form if you are not undergoing the free records evaluation and phone consult process. Thank you.

We strongly encourage our visitors to read our FAQs as well when considering the CEC for their care.

If you are unsure whether or not you've registered previously, or need to update your information on file with us, please email us to confirm we have your most current data. We do not keep registrations beyond one year prior for those who do not undergo review. Thank you.

Every registration is responded to by email with an information packet and necessary requirements for the free records review, usually within 24-48 hours except in select cases where otherwise noted. If you do not receive your packet, please check your spam file. Please take care to input your email address correctly, double-checking that you have given us accurate information. If you receive an email from one of our surgeons but not your packet of instructions, that means the mail went to your blocked/spam file. Please check and notify us accordingly.

Again - please remember: this form is NOT for those wishing to have an in-office appointment or existing patients. Do not use this form if you are coming to our offices. Please call 770-913-0001 to schedule your appointment and review costs, insurance, etc. Thank you.

Please understand that regrettably, we cannot process case reviews on an 'urgent' basis. Once discussed with Dr. Sinervo or Dr. Kongoasa, which takes 1-3 weeks from the time records are received, please allow approximately another 2 weeks for Jean to contact you to review scheduling, finances, hospital details, etc. We are currently booking surgeries 10 weeks out.

Please follow below with your registration details to get started. Please remember to fill out ALL AREAS OF REQUESTED INFORMATION (*=required), particularly full address details. You may enter 'n/a' where appropriate. Again, please remember this form is not for patients who have undergone treatment with us previously (from any year). Please do not register if you have been a CEC patient before; please contact us at 770-913-0001 and we will be delighted to help you with any concerns.

 

Date of Birth *
Date of Birth
Phone Number *
Phone Number