Forms

*We are not accepting new patient’s until further notice*

BEFORE COMPLETING THE NEW PATIENT APPLICATION PLEASE BE ADVISED THAT NEW PATIENT APPOINTMENTS ARE SCHEDULED FOR EVALUATION PURPOSES ONLY.

WE USE E-FORCSE® PRIOR TO PRESCRIBING ANY MEDICATION.

E-FORCSE®, the Florida Prescription Drug Monitoring Program
is a database we use to improve patient care by confirming a patient’s prescription drug history to identify potentially hazardous drug interactions.  As a healthcare provider our goal is to practice safe prescribing while helping to reduce drug abuse and diversion.

Please read the Office Policies before you download new patient forms.

 


DOWNLOADABLE FORMS  (Forms will open in a new browser tab)

Patient Forms:
You can help us make your first appointment even better by printing and completing the  forms in the New Patient Packet to bring with you for your initial appointment.

New Patient Forms Packet

Consent to release information

Notice of Privacy Practices



NOTICE:  The following YouScript® forms are OPTIONAL.
To participate in this service, print out and complete the forms and bring them with you.

YouScript®  Forms for pre-screening and requesting genetic tests that can identify your unique medication sensitivities.

YouScript® Risk Assessment Form  – A few questions to find out if testing can help you.

YouScript®  Requisition Form – Get  your testing started.


Technical Note:
PC Users: Our downloadable forms can be viewd and printed using Adobe Acrobat Reader 5 or greater.
Please download the free version from Adobe’s web site if it is not already installed on your system.

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