New Patient Packet

If you are a new patient, here are the new patient forms that you can fill out prior to coming in for your appointment. This will help us provide you with faster service and lesser waiting times at our office. Please
feel free to print and fill them out at your own convenience.

New_Intake___Physical_History_Form__New_Patient_Package_.pages
0.7 MB
3-8. Tricare Waiver-No Logo.pdf
18.5 KB
2-1._FPA_Notice_of_Privacy_Practices.docx
32.7 KB
2-2._FPA_Payment_Policy.docx
17.9 KB
2-3._FPA_Notice_of_Patient_Financial_Responsibility___Release_of_Info.docx
16.1 KB
2-4._Auth___Consent_for_Treatment.docx
15.6 KB
2-5._Acknowledgement_of_NPP.DOCX
19.7 KB
3-1. Auth to Use & Disclose PHI.DOCX
16.5 KB
3-2. FPA Auth to Verbally Discuss PHI.DOCX
19.5 KB
3-3. Disclosure of Ownership.docx
13.0 KB

Insurances

Here is an updated list of the insurances we accept:

Aetna Healthcare: HMO, PPO POS Open Access
Amerigroup
Americhoice
Avmed
Beech Street Network
Blue Cross Blue Shield: HMO, Blue Options, Select
BCBS Medicaid
Cigna: HMO, PPO, Open Access
Coventry
FHHS: HMO, PPOs, “Rosen Hotel”
First Health
Florida Healthcare Plus
Healthfirst
Great West Healthcare: HMO, PPO
Goldenrule
GHI
Health Choice
Humana: Military, HMO, PPO
Molina
PHCS (Private Healthcare Systems)
Prestige
Simply Healthcare
SouthCare
Sunshine
Tricare
Tricare Prime
United Healthcare Options
United Healthcare HMO
Wellcare / Staywell/ Healthease
Principal
Medicaid
Medipass

Call us at (407) 438 3557 if you have questions regarding any insurance questions. We will work with your insurance company whenever possible to obtain a consultation request.

Please be advised that we require a consultation request for all referrals made to this office, even if the patient’s insurance does not require referral to see a specialist. If you have any questions regarding this, please do not hesitate to call us.