ATTENTION NEW PATIENTS:

 

The medical provider cannot see you if these forms are not completely filled out and ready for the evaluation.

 

(You need a .pdf reader program installed to view and print each form)

 

Click on each form. You need to print each, fill it out completely, and bring it with you along with a photo ID and Insurance Card.

 

Below are the forms necessary for your evaluation:

·    Patient Information Form

·    Medical History Form

·    HIPAA Records Compliance Form (*)

(*)You may read the Notice of Information Practices referred to in the HIPAA Records Compliance form by clicking the following link: Notice of Information Practices

 

Please have these forms with you and complete before your appointment.  The medical provider cannot see you if these forms are not completely filled out and ready for the evaluation.

 

***Minor children must be accompanied by a parent or legal guardian ONLY.  Otherwise, you must provide written legal documentation showing that you have the right to consent to the child’s medical treatment.  See Florida Statutes: 743.0645(1)(c)