Forms
Welcome to our Office
See below for new patient paperwork. You can fill this out prior to your appointment if you want. ​
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We require your driver's license/ ID and insurance card.
Please follow this link to provide us with your demographics. We will call you to set your first appointment time and answer any questions.
This history allows us to understand your current and prior health conditions. We prefer that you enter your medical history into your portal and update annually.
Please use this form for medical records to be sent to another medical facility. Please make sure to fill out the address, phone number and fax number.
These forms are for the patients under the legal age of 18, and must be signed by their guardian in order for them to be seen as a patient. We collect their medical history, as well as their general information.
Cologuard Consent
This form provides the required consent for Cologuard. Your sample will be processed by Exact Science
Telehealth Informed Consent
Florida has laws to help you understand telehealth. Please review this information then provide consent if you are in agreement for your telehealth care
1. Authorization for Treatment
Universal Patient Authorization Form for Full Disclosure of Health Information for Treatment and Quality of Care
2. HIPAA Privacy
Health Insurance Portability and Accountability Act of 1996 requires patient consent for use and disclosure of protected health information. Here is our Notice of Privacy Practice for your review.
3. Financial Agreement
University Family Medicine will file your health insurance and you are responsible for copays and deductibles. Please provide current insurance.
4. Consent to use AI scribe during encounters
We use technology to help us provide you quality and cost efficient care. This is confidential and part of our health records software.