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Patient Forms

For your convenience we have most of our Patient Forms available for you to download and complete in the comfort of your own home.

When you book your appointment, our courteous staff will let you know which forms are needed for your next visit. Simply print, complete and email, fax, USPS mail or bring these completed forms by the office. Forms will need to be received by the office BEFORE an appointment can be set for any Telemedicine visits.

For New Patients, these forms must be submitted prior to scheduling your appointment so we can better serve you.

For those patients wishing to simply schedule a Thermogram, your forms can be submitted in the same manner as above.

A copy of patient photo ID (such as a driver’s license or state issued ID) is required to be submitted with all Telemedicine and New Patient forms. You can submit the form and photo ID to Joanne at this e-mail address, which is only available for submitting forms. Please do not use this e-mail to ask health-related questions.

Forms may be mailed, faxed or e-mailed and need to submitted at least 2 business days PRIOR to the appointment or the appointment will be rescheduled.





PLEASE NOTE!

BEFORE YOUR FIRST APPOINTMENT WE ASK OUR PATIENTS TO WATCH OUR PATIENT EDUCATION VIDEOS

CLICK HERE TO VIEW

(In order to better serve all of our patients we have provided these educational videos to help educate you about our services. Patients who have not watched these videos, prior to their first appointment, may be asked to reschedule their visit).

Patient Form Downloads

Welcome Letter Financial Responsibility New Patient Forms Packet

Detox Questionnaire Female Health Assessment Questionnaire Male Health Assessment Questionnaire
Caring for Both Men & Women
Ages 18 & Up

3643 Lake Center Drive
Mount Dora, FL 32757

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