PATIENT FORMS
New Patients
To help reduce your waiting time, you can print and complete the below forms prior to your office visit. Please bring them with you on the day of your appointment. Please complete all forms.
New Patient Registration (English)
Patient Medical History (English)
Medication History Authorization (English)
New Patient Registration (Spanish)
Patient Medical History (Spanish)
Privacy Notice (Bilingual)
Medical Records Release Form
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.
Insurance Information
Please send us an e-mail with your complete insurance information before your appointment. This will make your initial visit to our office more pleasant. Please do not hesitate to call if you have any questions.
Our number is (239) 304-2471.
PAYMENTS & INSURANCE
Private Practice
We see patients with NO insurance. We accept cash and Credit Cards as well as most health insurance plans. Please contact us for more information.
Insurance
We accept most health insurance plans:
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Aetna
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Avmed
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Cigna
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Florida Blue/ Shield
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Medicaid
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Medicare
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Staywell/Wellcare
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Multiplan
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Tricare
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United Health Care
Please note this is not a complete list of all the insurance plans that we participate with and are subject to change. Please contact our office for more information or contact your insurance carrier.
Payment for Co-pays and Self-pay patient charges is expected at the time of service. For your convenience, we accept Cash, personal checks, Visa, and MasterCard.
MAKE AN APPOINTMENT
Walk-In Services are available every day during our business hours.
Do you have any inquiries?
Please contact us at any time.
at our Clinic
5580 19th Ct SW, Suite 2
Naples, FL 34116
by Phone or Fax
Phone: (239) 304-2471
Fax: (239) 304-2741
by Email
or Book you Appointment online
45 min
Prices may vary
45 min
Pirces may vary
1 hr
Prices may vary
45 min
Prices may vary
45 min
Prices may vary