Patient Info

Patient Portal

Pay your Bill OnlineThe Portal is a secure and convenient place to manage your health records and those of your family members as well.

Login to Patient Portal

New Patient

Before 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.

New Patient Information
Medical Questionnaire
HIPPA Privacy Policy
Medical Release Form

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Insurance policy

checkOutWe 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), Care Credit.

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
AvMed
BCBS Exchange Plan
Cigna
Cigna (all Great West Plans)
Coventery (commercial HMO, POS, PPO)
Florida Blue
Humana (Except Gold Plus or Humana X)
Medicare
Molina
Multiplan
Staywell
Tricare (standard, life and prime)
United Healthcare
United Healthcare Compass Plan
Wellcare

Insurance plans we do not except:
Amerigroup
Coventry Exchange
Humana X
Humana Gold Plus
Cigna Local Plus plan

Release of Medical Records

If you would like us to release your medical records, please complete the request form below and submit to our office.

Medical Release Form

Minor Policy

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.

Minor Release Form

Call Us at 813.960.2400