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
Reduce your wait and bring the following forms to your initial appointment.
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
Please read our HIPAA policy.
- Aetna (HMO & PPO)
- Beechstreet Health Plans
- Evolutions Healthcare
- Florida Blue
- Gator Group
- GENEX / Choice Provider Network
- Heritage Summit
- Medicare Railroad
- PUP Medicare
- Secure Horizons
- Simply Healthcare
- United Healthcare Medicare
- Workers’ Compensation
Contact Us To Make An Appointment
Flexible appointments and urgent care.
Call us: 904-621-0247