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Adobe® Acrobat® Reader®
is required to view the following forms. To download
this free
software click
here.
New Patients
To help reduce your waiting time, you
can print and complete the below forms prior to your
office visit. Please bring them with you, rather than
mailing or faxing them to us.Please complete all six
(6) forms.
- Patient Registration Form
- History
and Physical (2 pages)
- HIPAA
consent form
- Referral Policy
- Lab Policy
- Patient Financial Policy
If you need any assistance
with these forms please feel free to call (407) 345-0005
X 101 or 105
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Your medical records are
completely private. To ensure patient confidentiality,
and conforming to HIPAA
regulations, no information regarding your condition
will be released by this office to anyone, including
any family member, without your written consent.
- Medical
Records Release Form
If you need any assistance
with this form please feel free to call Medical Records
(407) 345-0005 X120 |
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