Patient Forms Packet
Save time in the waiting room! Please print and complete the forms packet before your appointment and bring them with you to your appointment.
- New Patient Packet – 3 pages
If you need an individual form, please choose from the list below.
- Authorization for Release of Protected Health Information
- The Health Insurance Portability and Accountability Act of 1996 Disclosure Form
- Financial Agreement for Injections
- Notice of Privacy Practices – print for your records
Appointments can be made by calling our office during normal business hours: 850-818-0021.
All office visits are payable at the time of service. We accept cash, cashier’s check, and all major credit cards and debit cards. Please contact our billing office should you have any financial questions or concerns.
Prescriptions are renewed during normal office hours. We may require that the patient be seen in our office prior to medication renewal or for pain medication refills.