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John B. Whitlow, O.D.
Donna G. Whitlow, O.D.

706-882-0616

At West Georgia Vision Center, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to download and complete the forms. Click here to download. Download the Free AdobeReader®

  • Download the required form(s). Print out the form(s) and complete the required information.

  • Fax your printed and completed form(s) to our office (fax 706-882-8515) or bring them with you to your appointment.


Patient Information Form

Please complete this form for required information to complete your patient chart.  Please note that the parent or guardian should sign the form if the patient is under 18 years old.

Download & Print Patient Information Form


Patient Health History Form – Required

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form. (This form has 2 pages.)

Download & Print Health History Form


Notice of Privacy Practices

We respect our legal obligation to keep health information that identifies you private.  The law obligates us to give you notice of our privacy practices.

Download & Print Privacy Practices


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