University Family Medicine Center, PA
10055 University Blvd Orlando, FL 32817
Phone 407-679-4800 Fax 407-679-0574
Text 407-679-4800
Ronald Burns, DO
Sarah Norman, APRN
Ana Greenwood, APRN
Forms and Documents

Welcome to our office: A Letter To Our Patients
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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.
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Insurance questions? We have some info here, or you can email us if you have further questions.
New Patient Information Form
This is a mandatory form and must be filled out completely. Please include all contact information. We do use e-mail and text.
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HIPAA Form
Health Insurance Portability and Accountability Act of 1996 requires patient consent for use and disclosure of protected health information. This is a law to safeguard your personal information.
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Medical Release
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.
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Adult Medical History
This history allows us to understand your current and prior health conditions. It helps us identify any future health problems that may come from your family history.
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Pediatric Form
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.
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Advanced Care Directive
What is an Advanced Care Plan? Advance care planning (ACP) is the face-to-face time a physician or other qualified health care professional spends with a patient, family member, or surrogate to explain and discuss advance directives.
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