(904) 621-0247

Patient Center

Thank you for trusting us with you and your family’s care. Please find forms on this page to bring prior to your first visit as well as a list of accepted insurance providers. To make an appointment, please call us.

Call (904) 621-0247

Patient Forms

Reduce your wait and bring the following forms to your initial appointment.

Patient Forms

Please complete, sign and bring to initial visit. These packet includes the following forms:

  • Patient Information
  • Initial Visit Information
  • Authorization for Release of Protected Health Information (PHI)
  • Financial Policy
  • Informed Consent for Treatment with Opioid Medications
  • Notice of Privacy Practices (HIPAA)
  • Acknowledgement of Privacy Notice

HIPAA Policy

Please read our HIPAA policy.

Accepted Insurances

We accept most major insurances. Insurance is subject to change. Please call our office to confirm.

  • Aetna (HMO & PPO)
  • AARP
  • AvMed
  • Beechstreet Health Plans
  • Cigna
  • Coventry
  • Evolutions Healthcare
  • Florida Blue
  • Gator Group
  • GENEX / Choice Provider Network
  • GHI
  • Heritage Summit
  • Medicaid
  • Medicare
  • Medicare Railroad
  • Molina
  • Multiplan
  • PHCS
  • PUP Medicare
  • Rockport
  • Secure Horizons
  • Simply Healthcare
  • Tricare
  • United Healthcare Medicare
  • Wellcare
  • Workers’ Compensation

Contact Us To Make An Appointment

Flexible appointments and urgent care.

Call us: 904-621-0247

We Treat You Like Family

CONTACT US NOW TO MAKE AN APPOINTMENT

(904) 621-0247

Green Cove Springs

3189 US Highway 17
Green Cove Springs, FL 32043