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 <This form has 8 pages)

· 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)

YOUR APPOINTMENT FOR EVALUATION

You should expect to be in our office for about 2 hours for your first appointment.  Upon arrival we will collect the completed documents from above, along with a picture ID and insurance card.  Our staff will scan your cards and enter some data from the forms you filled out.  You may also be taken by the medical assistant to take your vitals ( ie: height, weight, blood pressure).  You will then be sent to a staff member to complete your registration, which includes: signatures on consent forms, photo for the electronic chart, and explanation of insurance benefits (based on what we were quoted by your insurance company), and collection of any payment due.  You will be then be ready for evaluation, which should take about one hour, face to face with the clinical staff member.