New Patient Registration Packet (3 Forms Below)

New Patient Form

Assignment of Benefits/Financial Responsibility/Treatment Consent

HIPAA/Privacy Consent

Additional Consent Forms

Flu (Influenza) and TB Consent

Pneumococcal Vaccine

Procedure Consent

Medical Records Release Form

Medical Information Sharing


DOT Physical

Driver Applicant

Florida Workers’ Compensation

School Forms

Florida School Entry

Sports Physical for High School in Florida

Florida Immunization Record

Youth Camp Physical

Girl Scouts Form

Boy Scouts Physical

Patient Logs

Blood Pressure Log

Blood Glucose Log

Medication List Template

Affordable Care Clinics HIPAA/Facility Privacy Statement

Facility Privacy Statement