PATIENT FORMS

Click to Download the Forms below:

• • Ear Piercing
  • Flu Vaccine Consent Form
  • Flumist Consent Form
  • Insurances We Accept
  • Newborn Circumcisions
    (Up to 2 weeks old)
  • New Patient Prenatal Paperwork
    
  • New Patient Paperwork: To better serve our current patients, we will no longer be accepting new patients at this time as of 10/9/23. We apologize for any inconvenience.
  • New Patient Questionnaire
  • Office Fees
  • Office Policies
  • Vaccine Schedule

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

  
  
  
  
  

  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) Sunshine CMS Health Plan – by CMS referral only for existing patients (We do not accept any other Sunshine Health plans)

  We are no longer contracted providers with: BCBS HealthyKids BCBS myBlue HMO Humana Tricare UHC Rivervalley HMO

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