Forms

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.

Complete & return all forms that apply

1.  New Patient Forms
2.  Existing Patient Forms
3. Established Patient Annual Visit Form
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.)

Our Office:
7401 N UNIVERSITY DR STE 101
TAMARAC, FL, 33321
phone: (954) 722-2002
fax: (954) 722-2041

Office Hours:
Monday-Thursday: 9am-5pm
Friday: 9am-12pm