Call Appointment Portal
Appointments

 

Patient Portal

Patient Resources

Patient Portal

Welcome to our HIPAA SECURE patient portal. Any current patient who has previously registered to use our Web Portal may sign in using this link.

Enter

Appointments

Call our reception desk at (850) 391-6222 or click on this link to schedule an appointment online.

Schedule

Patient Forms

Forms for New and existing patients can be viewed and printed by clicking on this link. Please feel free to fill out appropriate forms and fax to our clinic number at (888) 698-2714.

Forms

PATIENT FORMS

New Patient Forms

All New Patient Appointments and Annual Wellness Exam Appointments will need to fill out these three Forms:

New Patient Information Form: .PDF .DOC

Medical and Social History Form: .PDF .DOCX

Doctor Visit Preparation Form: .PDF .DOC

Other Forms

To enable us to request medical records about you from other health care providers or hospitals, please fill out this form and return it to us:

Records Request Release Authorization Form: .PDF .DOC

Your medical records with us are confidential. To enable us to send your medical information to other providers or family members please fill out this form and return it to us:

Medical Information Disclosure Form: .PDF .DOC