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Forms
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Want to Speed Up the Process?
Complete these forms & bring them to your visit along with:
1. Current Insurance Card.
2. A Complete List of your Medications.
3. Records from your other Doctors.
4. Recent Hospital, ER Visits.
5. Labs & Test Results from the last 12 months.
Click on the appropriate forms, below, complete & bring them to your visit.
1. New Patient Forms
2. Established Patient Annual Visit Form
3. Notice of Privacy Practices ( to be completed by EVERY New patient )
4. Medicare ABN Form (to be signed every year by every Medicare patient)
5. Medical Record Release Form (Use this form in advance of your visit to request: Office, Hospital Records, LAB & Test Results. You may make multiple copies as needed. Mail or fax completed forms to your providers and bring copies with you to your appointment.)
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Our Office:
7401 N UNIVERSITY DR STE 101
TAMARAC, FL, 33321
PHONE: (954) 722-2002
FAX: (954) 722-2041
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Office Hours:
Monday-Thursday: 9am-5pm
Friday: 9am-12pm
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