Your medical records are confidential. You must request the release of this information to any outside facility or agency. This policy allows us to protect your privacy. Please make us aware of the name and address of your local physician who should receive a report of your hospital or office visits.
If additional copies are requested for other physician offices, government agencies, insurance carriers or your personal use, you will be charged for this service. Learn more below regarding policies and procedures.
Document Download Center
The forms are in PDF format. Download the form. Print and complete the form.
Do one of the following:
- Fax the form to: 407-859-3815
- Scan the form and email to: firstname.lastname@example.org
- Bring the completed form to your appointment
- Notice of Privacy Practices
- Health Insurance Portability and Accountability Act Form (HIPAA)
- Patient Insurance Form
- New Patient
- Medical Information
- Patient Questionnaire
- Financial Policy
- Team Approach to Patient Care
- System Review