Patient Forms

Things to remember to bring on your first visit:

• Insurance Card
• Photo Identification
• Referral from your primary care physician
• Health Information related to your current illness (CT scan, lab work, sleep studies etc.)
• Co-pay (personal checks are not accepted)

All new patients are encourage to print and fill out the forms below and bring them with you to your appointment or fax to (407) 891-2011. This will expedite your visit. All files are in PDF Format (if you don't have a PDF reader, click on the button at the bottom of the page).

• Financial Policy
• New Patient Registration
• Medical History
• Review of Systems
• Release of Medical Records

Insurance

We participate with the following insurance plans. If you do not see your insurance listed please call the office to check your health insurance company. Please consult your insurance company and your provider directory to confirm that we participate with your plan.

Aetna	Evolution PPO	Physician United	Integrated Administration
AvMed Health Plans	Great West Health	Choice Care PPO	PHCS
Beech Street	Humana	Coventry Health Care	Three Rivers Provider
Blue Cross/Blue Shield	Medicare	MD Choice Medicare	United Healthcare
Cigna	Multiplan	Prime Health	Vista Health Plan
Citrus Health Care	CarePlus Medicare	PA Access