Quick Message Form
Quick Message Form
Note: this form is NOT sent over an encrypted connection. Do NOT send HIPAA protected information using this form. If your matter is urgent, please call our offices at 407-
It’s time to do something about your allergies
New Patient Forms
Please download and complete the necessary patient forms. These forms are available online for your convenience. Please open these forms by clicking the “click here to download” button. The form will open up in a new window in your browser. Please complete these forms by either typing directly into the form from your browser and print out the completed form or print them and complete them by hand. Please bring the completed forms with you to your next visit. Questions? Call us at (407) 380-
Authorization To Come Alone
Authorization To Come With Another Adult
Allergy Shot Consent Form
Shot Info Pack
Summary of Privacy Practice
Financial and Insurance Policy
- School Medication Forms and Treatment Plans: NO CHARGE
- Permanent Disability Forms: $75.00
- Short Term Disability Forms: $50.00 (includes completion of FMLA, as well as any required records and follow up forms related to this incident.)
- FMLA Paperwork: $35.00
- Letters: $25.00
- Other Forms: Call office
Patient must be current on office visits for forms to be completed. Please allow up to one week for pickup of completed forms.
- Medical records will be sent to other physicians at no cost to patients after obtaining a valid medical record release form from the patient.
- Patients requesting copies of medical records for personal use will be charged a copying fee of $1.00 per page for the first 25 pages copied, then $0.25 for each additional page. Payment is required prior to records being released.
- Allow up to 2 weeks for copies of records.
Release Medical Records To Us
Release Medical Records From Us