Contact Us

If you have a medical emergency, please call 911.

Our representatives can assist you in English or Spanish.

Contact Information

Phone: 770-417-8170
Fax: 1-855-530-3640

Office Hours

Monday - Friday: 8:30 a.m. - 5:00 p.m.

Address

Home Dialysis Institute of GA
575 Professional Drive, Suite XXX
Lawrenceville, GA 30046

Request Consultation

Using our consultation request form below, you can request a consultation with our office anytime and our staff will follow-up with you to confirm your appointment.

Patient Information

Patient Name:
Patient Date of Birth:
New or Existing Patient?	New Patient Existing Patient
Home Phone:
Cell Phone:
Preferred Contact Method:	Home Phone Cell Phone
Email Address:
Insurance:

Appointment Information

Preferred Provider:	No PreferenceFirstname Lastname 1, MDFirstname Lastname 2, MDFirstname Lastname 3, MD
Preferred Day:	Monday Tuesday Wednesday Thursday Friday
Preferred Time:	Morning (AM) Afternoon (PM)
Secondary Preferred Day:	Monday Tuesday Wednesday Thursday Friday
Secondary Preferred Time:	Morning (AM) Afternoon (PM)
Question/Comment: