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Forms & policies

To help save you time, we’ve gathered all the important forms and office policies right here

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General forms & policies

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Florida Patients Rights & Responsibilities

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Informed Consent for Telemedicine

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Request Medical Records

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Request for Correction or Addendum for PHI

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Request for Account of Disclosure

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Request for Confidential Communications

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Notice of Patient Privacy

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Non-Discrimination and Language Policies

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Request for Restriction and Limitation of Protected Health Information

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Terms of Use

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Website Privacy Statement

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Social Media Guidelines

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Disclaimer

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Cookies Notice

Billing and Collections

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Patient Financial Assistance Policy

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Financial Assistance for Medical Care

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Financial Assistance Application Checklist

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Financial Assistance Application

Well Visit Assessment Forms

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TB (Tuberculosis) / Cholesterol Risk Assessment

Attention Deficit Disorder & Hyperactivity Disorder Packet (ADHD)

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Parent Packet

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Parent Packet Follow-Up

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School Packet

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School Packet Follow-Up

Language assistance and communication aids

We provide services to individuals who need assistance to communicating with us. If you need an interpreter or other communication assistance, please notify any member of our staff in person or via phone at 855-543-9362.

Our team will promptly connect you with a qualified interpreter to help ensure clear and accurate communication during your visit.

Ready when you are