Patient Forms
Please complete the forms listed below prior to your office appointment. You may click the form name to open the form online and complete, or you may click the form name and print a paper copy for completion. Please be sure to bring all completed forms with you. Thank you, and we look forward to seeing you.
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Please read this Notice before completing the Acknowledgement Form listed below: Notice of Privacy Practice (English) or Notificacion De Politicas Privadas (Spanish)
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Acknowledgement of Receipt of Privacy Policies (English) or Acknowldegement of Receipt of Privacy Policies (Español)
Do you have an Advanced Directive or a Living Will? These documents are intended to create a legal record of your opinion on end-of-life treatment at a time when your are of sound mind and body, therefore, enabling doctors to honor your wishes. These documents can also serve to avoid confusion or additional hardship for your family and friends who otherwise would be asked to make medical decisions for a loved one receiving end-of-life treatment without necessarily knowing what he or she might have wanted. Below are links to current documents published by the State of Florida, as required by the Florida Statutes Section 765.303. In addition, you may contact the Florida Agency for Health Care Administration at 888.419.3456.
Should you have any questions, please do not hesitate to contact our office so that we may provide you with the assistance you need prior to your appointment.
