PATIENT FORMS
Click to Download the Forms below:
New Patient Paperwork: To better serve our current patients, we will no longer be accepting new patients at this time. We apologize for any inconvenience.
Privia:
- Notice of Privacy Practices (PDF)
- Authorization for Release of Medical Information (PDF)
- Authorization and Consent for Treatment (PDF)
- Preferred Contacts (PDF)
- Financial Policy (PDF)
- Language Services
You will need "Adobe Reader" 
to properly view the pages of these documents. A free copy of the Adobe Reader program is available at the following web site:
We accept most major insurances (except Medicaid or any government funded insurance).
We currently accept the following insurance networks:
- Advent Health Plans
- Aetna
- Avmed
- Beechstreet
- Blue Cross Blue Shield
(We do not accept BCBS HealthyKids, or myBlue HMO Plans)
- Cigna
- Coventry /First Health
- Golden Rule
- Great West
- Medishare / Christian Care Ministries
- Multiplan / PHCS
- Prime Health Services (FL Sheriffs)
- UMR
- United Healthcare
(We do not accept UHC Rivervalley HMO/NHP, FLONEX, or UHC Exchange Plans)
- Sunshine CMS Health Plan - by CMS referral only for existing patients
(We do not accept any other Sunshine Health plans)
.: Pediatric Associates of Ocala :.
