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New Patient FormsBefore your appointment please download our PDF forms below. Fill out ALL of the following forms before your scheduled appointment. NOTE: Sections of these forms are interactive and you can fill them out online. Be sure to print them out when completed and bring with you to your appointment. Please be prepared to provide this information along with your current medical insurance information at the time of your appointment. If you have any questions regarding completing the forms, our staff will be happy to assist you on the day of your appointment Please remember to bring your identification and insurance cards.
We will file all claims to insurance companies for services rendered. Any expenses not covered by your insurance must be paid for on the day of your appointment. This may include deductibles, co-insurance, co-pay amounts, occasional office visits, and cosmetic procedures.
Payments may be made by: Cash, Check, Credit Card (Visa, MasterCard, American Express, Discover).
Your insurance policy is a contract between you and your insurance company. We are not a party to that contract. If your insurance company has not paid your account, the balance will be billed to you for payment. Please contact our office if there is any assistance we may provide in this matter.
If your plan requires a prior authorization or referral, please contact your insurance company or your referring physician at least one to two weeks prior to your appointment. This must be completed prior to arrival in our office.
Insurance Plans Accepted
- Aetna (All plans)
- Aetna Exchange plan
- BCBS Exchange Plan
- Cigna (all Great West Plans)
- Coventery (commercial HMO, POS, PPO)
- Florida Blue
- Humana (Except Gold
- Plus or Humana X)
- Tricare (standard, life and prime)
- United Healthcare
- Compass Plan
Insurance plans we do not except:
- Coventry Exchange
- Humana X
- Humana Gold Plus
- Cigna Local Plus plan
If under the age of 18 years of age, you will need to be accompanied by a parent or legal guardian. If the parent(s) or legal guardian(s) are unable to be present, a written letter giving permission for the provider to evaluate and treat the minor will be accepted; treatment provided without a consent could be considered unprofessional conduct under the Medical Practice Act, and physicians’ licenses to practice medicine can be suspended for unprofessional conduct. If we are unable to receive this letter unfortunately the minor’s appointment will need to be rescheduled.