Holly Springs, GA · Cherokee County
Medical Establishment Questionnaire
This questionnaire collects business and service details from applicants proposing a medical establishment or pharmacy in Holly Springs.
What this form is
Applicants for a proposed medical establishment or pharmacy use this questionnaire to provide business information and describe the services they intend to offer. It asks about pharmacy treatment services and the prescribing or dispensing of certain drugs, and collects information about the active manager and, when the business is incorporated, its registered agent or officer. Applicants and owners or corporate officers sign to attest that their answers are true.
Who needs it
Applicants representing a proposed medical establishment or pharmacy, and the establishment owner or corporate officer when different, complete and sign the questionnaire.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This questionnaire is signed and dated without a notary; the applicant and owner or corporate officer sign to attest that the information is true.
How to submit this form
- 1
Download The Questionnaire
Download the Medical Establishment Questionnaire PDF.
- 2
Complete The Questionnaire
Fill in the business, proposed services, active manager, and registered agent or officer information, as applicable.
- 3
Sign And Date
The applicant and establishment owner or corporate officer sign and date the questionnaire.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Who completes the Medical Establishment Questionnaire?
- Applicants representing a proposed medical establishment or pharmacy complete the questionnaire. The establishment owner or corporate officer also signs when they are not the applicant.
- What information does the questionnaire ask for?
- It asks for business and manager information, proposed services, and details about pharmacy treatment services and prescribing or dispensing certain drugs.
- Do I need a notary for the Medical Establishment Questionnaire?
- No. The document has signature and date lines for the applicant and owner or corporate officer, but no notary block.
- How do I submit the Medical Establishment Questionnaire?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Medical Establishment Questionnaire doesn’t need a notary — but if you have another Holly Springs form that does, a commissioned online notary can help.