Newman Family Medicine

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New Patient Information

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FHMG Patient Info and Consent.pdfPlease print the following eight New Patient forms, fill them out completely and bring them with you to your first appointment.

  • NEW Patient Demographic Form
  • Patient Information.pdf

  • History and Physical.pdf

  • Consent For Evaluation or Treatment.pdf

  • Written Acknowledgment.pdf

  • Attention All Patients.pdf

  • Communication Use And Disclosure Authorization.pdf

  • Patient Privacy Notice (HIPAA).pdf

 

Miscellaneous Patient Forms
  • Advanced Beneficiary Notice of Noncoverage.pdf
  • Authorization to Treat Minors.pdf
  • General Waiver for Non-Covered Services.pdf
  • Authorization for Use and-or Disclosure of Protected Health Information - Pg. 1.pdf Authorization for Use and-or Disclosure of Protected Health Information - Pg. 2.pdf

 

 

 




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Newman Family Medicine

661 E. Altamonte Drive , Suite 115, Altamonte Springs, Florida 32701
Phone (407) 831-4040 Fax (407) 260-0281
McMurry