FHMG Patient Info and Consent.pdfInitial Office Paperwork

Please complete the following forms before your initial office visit:

• NEW Patient Demographic Form
• Past Medical History form
• Patient Information Form
• Insurance Information Form
Communication Use and Disclosure Authorization Form
• 24-Hour Advance Notice Form
• Written Acknowledgment of Receipts Form
• Release of Medical Records Form 
• HIPAA Statement
   

School and Day Care Forms

• Blue Vaccination Forms
• Florida Sport Physical Forms
• Gold School & Day Care Physical forms
• School Absentee Form

Please provide the forms listed above. Please call us at least 24 hours before the completed forms are needed.

The Florida Sports Physical forms is available in the link above. If your child has had a Physical or Well Check within the last year, please fill out page 1 of the Florida Sports Physical form and drop it by the office.

In addition to the forms listed above, please provide copies of your child’s immunization records if he or she received vaccinations from another office.

Regarding the School Absentee Form, we can only vouch for the days missed due to the actual doctor’s appointment or the days recommended by the doctor at the initial office visit.