To help reduce your waiting time, you can print and complete the below forms prior to your office visit.
Please bring them with you, rather than mailing or faxing them to us. Please complete all forms.
- Patient Information Form
- Patient Financial Policy
- Permission To Communicate With Family
- Appointment Cancellation Policy
- Medical Release-HIPAA Consent Form
- Health History Questionnaire
- Skincare Questionnaire & Waiver
- Hormonal Imbalance Questionnaire for Women
- Hormonal Imbalance Questionnaire for Men
If you need any assistance with these forms please feel free to call (352) 243-3555
Your medical records are completely private. To ensure patient confidentiality, and conforming to HIPAA regulations, no information regarding your condition will be released by this office to anyone, including any family member, without your written consent.
If you need any assistance with this form please feel free to call SunCoast Premier Medical @ (352) 243-3555