Patient Forms

These are patient documents that you can download, print, and fill out, prior to your office visit.  

These are patient documents that you can download, print, and fill out, prior to your office visit.  Please read the directions below carefully to ensure you are able to successfully complete the forms.

Once filled out and saved, these forms can be submitted through fax to (386) 677-7842.  

Only sign these forms if you are printing them at home.  If you are submiting these forms via fax, please do not sign them electronically.  We will ask you to sign them when you arrive at the office.

– New Patient Form –
Arthritis and Autoimmune

New Patient Form for patients seeking care with Arthritis or Autoimmune related problems.

– New Patient Form –
Allergy

New Patient Form for patients seeking care with Allergy related problems.

Medical Release Authorization Form

Authorization to Disclose Protected Health Information

Notice of Privacy Practices Form

This form outlines how your medical information may be used by our office.

Payment Authorization Form

New payment authorization form for Navicure Payments, applicable to all patients.