Patient Forms

ARILEX Center for Endometriosis and Pelvic Pain, led by board-certified anesthesiologist Gary G. Theofilis, DO, MBA, DABAM, DAAIM, is an advanced pain treatment facility that caters to women in or around Atlanta, Alpharetta, Johns Creek, and Milton, GA, and around the country. 

We strive to see all patients within 24 hrs. We will do our best to see patients in need on the same day.

New Patient Forms are located below. Please download these PDF Forms and have them completed prior to arriving to our office. All Patients must bring the following information with them to EVERY VISIT.

  • Valid US Drivers License

Below are the required forms for all new patients. It is recommended that you download and complete the forms prior to your initial visit. If they are not completed in advance, please arrive 30 minutes prior to your appointment time to complete this information. Failure to do so may result in the delay of your appointment time.

New Pt Intake Form
New Pt HIPAA Compliance
New Pt Financial Responsibility
New Pt Records Release

If you are suffering from pain that is affecting your quality of life, contact ARILEX Center for Endometriosis and Pelvic Pain. Download our patient forms today to help you prepare for your appointment. We serve residents in the Atlanta, GA, area as well as out-of-state residents.