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Now Accepting New Patients.

For same-day appointments, call 407.578.6610. We will try our best to accommodate your request.

Download New Patient Form Here

NEW PATIENT FORM

  • Personal Contact Information
  • Guardian information (if necessary)
  • Reason for visit

Patient Pre-Registration:

 

To ensure we have current patient information, patients will be asked to fill out a brief form during each visit.

 

Please have the following information available:

  • Employment information
  • Current insurance information.
    If you do not have insurance,
    ask us about other financial options.
  • Social Security Number

First Visit

Please arrive 20 minutes prior to your appointment and bring the following items:

  • Valid form of identification
  • Relevant medical information
  • List of current prescription and non-prescription medications
  • Copy of insurance card (required for each visit)

 

Payment is expected at the time of service.

 

Late Patients

We will do our best to accommodate late patients; we may have to reschedule.

 

Prescription Refills

Call your pharmacy several days before your medication runs out. The pharmacy will fax a refill request. We may request that you make an appointment prior to refill authorization.

 

If a new prescription is required, your pharmacy will notify us. Your provider will either fax the prescription to the pharmacy or call you to set up an appointment.

 

Medical Records

To request a copy of your medical record, please sign a release of information and indicate the specific information you are requesting. Payment is due when the request is submitted. We will contact you when the records are ready. We provide medical record information to physician’s offices at no charge.

 

Insurance/Payment Information

Claims will be submitted directly to your insurance carriers. Patients are responsible for deductibles and copays at the time of service.

 

10000 W. Colonial Drive Suite 187, Ocoee, FL 34761

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