New Patient?
We are welcoming New Patients. You must call to establish with us before we schedule your annual physical exam. Please have the following information ready when contacting us:
Name • Date of Birth • Phone • Email • Address • Insurance Card (if applicable)
Complete the forms below and submit them securely along with your insurance card using this link, and a member of our team will be in touch.
You must download Adobe to complete these forms.
Forms
If you are an existing patient and are looking for helpful forms such as blood sugar logs or care instructions, please view the resources we offer below.
Annual Wellness Visits
An annual wellness exam or visit is an important part of preventative care. These annual visits with your primary care doctor allow for a yearly health assessment to make sure you are in good health and catch any issues that may arise early. As you prepare for your annual wellness visit, make sure to: fill out the form below and write down any questions you may have for your provider and bring them with you to your appointment.
Accepted Insurances
We accept the following major insurances. This list is not comprehensive and is not a guarantee of coverage or benefits.
- Advent Health Allegiance
- Advent Health Bright Health
- Advent Health Oscar
- Aetna
- Aetna/Coventry
- Aetna/First Health
- Champ VA
- CIGNA
- Disney Cruise Lines
- Florida Blue HMO
- Florida Blue MyBlue
- Florida Blue NWB
- Florida Blue PPACA
- Florida Blue PPO
- Florida Blue Traditional
- Health First Health Plans
- Humana Military
- Liberty Health Share
- Medicare
- MultiPlan/PHCS Commercial
- Orlando Health CIN Aetna
- Orlando Health CIN Aetna Whole Health
- Orlando Health CIN Allegiance
- Orlando Health CIN Employer Health Network
- Orlando Health CIN Florida Blue
- Prime Health Services Commercial
- Prime Health Services Commercial
- Provider Networks of America Commercial
- Tricare for Life
- United Healthcare (VA)
- United HealthCare / Neighborhood Health Plans
- United HealthCare Commercial
*Starting 2020 we will accept both Commercial and Medicare Bright Health Insurance Plans.
Patient Forms
- Notice of Privacy Practices (PDF) – Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
- Authorization for Release of Medical Information (PDF) – Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
- Authorization and Consent for Treatment (PDF) – All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of
financial responsibility. Autorización y Consentimiento Para el Tratamiento - Preferred Contacts (PDF) – Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos
- Financial Policy (PDF) – This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
- Language Services