Patient Forms

General Forms

• File

  Non Discrimination Notice - Spanish
• File

  Non Discrimination Notice
• File

  Patient Satisfaction Survey
• File

  Patients Bill of Rights
• File

  Physician Ownership List
• File

  Advanced Directives
• File

  Disclosure for Out-of-Network Benefits
• File

  Patient Disclosure of Information
• File

  Pre-Anesthesia Assessment
• File

  Right to Receive a Good Faith Estimate of Expected Charges
• File

  Notice Regarding Patient Protections Against Surprise Billing

Florida Transparency Bill

• File

  Financial Policy
• File

  Financial Form Verification

Services may be provided by other healthcare providers who may bill separately.

Northstar Anesthesia
6225 N State Hwy 161 Ste 200
Irving, TX 75038
(800) 930-6313

Pathology Specialist PA
84 W. Jersey
Orlando, FL 32806
(407) 648-4399

Ameripath
8150 Chancellor Driv Ste 110A
Orlando, FL 32809
(800) 395-7884

Advent Health Fish Lab
1055 Saxon Blvd.
Orange City, FL 32763
(386) 917-5107