Provided below are various forms that require completion prior to your visit, or that may need updated during the course of your establishment. If you cannot access these forms, you may need to download the Adobe software located at the bottom of the patient form tab. This free software will allow you to view and access the forms properly.
If you need help completing these forms, have questions about our treatments and procedures, or need to schedule an appointment, please call us at (321) 453-1955.
**New Patient Appointments Steps**
Below are the steps to follow to schedule a new patient appointment to become established at our practice:
- Call our office to check available times for new patient appointments with the provider with whom you wish to establish. At this time, the scheduler will confirm whether or not we accept your health insurance plan. Cash-pay patients are welcome in our practice. You may also search to confirm your plan is in network under the insurance information tab.
- Next, you must submit the completed new patient paperwork forms prior to actually scheduling a new-patient appointment. Please understand that this is necessary to deter unwanted appointments that people sometimes make, causing a delay for those that intend on establishing with our practice.
Ways in Which You Must Submit Your Forms
- In-person (preferred)
Proceed to the patient forms tab and click on “new patient forms”. Download/print all of the forms in that tab. Please have all information on forms completed and signed. Bring the completed/signed forms to the office. Alternatively, you may stop by the office and ask for the forms, complete them and turn them in.
- Fax or mail the forms
Follow the same steps as above, but also include a clear, legible copy of the front of your driver’s license (or legal ID) and both the front and back of your health insurance card(s).
Mail to: 1395 N Courtenay Pkwy, Ste. 107, Merritt Island, FL 32953, or
Fax to: (321) 454-2406
Regardless of which option you choose, make sure all patient forms are printed out, filled in completely, and signed. Also, provide a clear copy of a legal ID (such as a driver’s license), as well as both the front and back of your insurance card(s). Appointments will not be made without receipt of all required material as listed above.
- Finally, once all of the paperwork has been received, you may call the office to schedule your new patient appointment.
New Patient Forms
Parental Consent Form
Record Request Form
Patient Information Form
Medical History Form
Notice of Privacy Practices
HIPAA Release FORM
Please note: These documents are in Adobe® PDF format. They require Adobe Reader to be viewed. If you do not have Adobe Reader, you can download it for free by CLICKING HERE.