Instructions for New and Updating Patients

Please fill out “Patient Information” Section as completely as possible.

If the patient is Under 18 years of age the parent that is accompanying the patient needs to fill out “Guarantor (Responsible Party) Information” section.
Insured (Policy holder) information —Primary Carrier needs to be completed as well as the “Insured (Policyholder) Information—Secondary Carrier if it is applicable.

Then you can Sign & Date at the bottom of the form after printing it out.

Items to bring with you to the appointment

• Name and address of primary care physician
• A complete list of current medications and list any allergies that you may have
• Photo I.D
• All health insurance cards (primary and secondary)
• Pharmacy name and phone number that you will want your prescriptions’ sent to electronically

• Current & New Patient Documents

  

• Office Locations

  Ocala
  The Villages