Plan Your First Visit at Family Practice of CentraState

couple with computerFor your convenience, the following forms are available for printing and completion. To reduce the paperwork required during your first doctor visit, you can print out the Registration and HIPAA Acknowledgement forms, complete them and bring them with you on the first visit to our office for processing. Please bring your current insurance card.

Co-payments are required at the time of service. You may also have your records transferred from your prior physician to Family Practice of CentraState by completing the Transfer Records form and sending it to your prior physician.

Viewing the forms requires Adobe Acrobat Reader, available for free below.

 

New Patient Registration Form

Record Transfer Form

Notice of Privacy Policy- HIPAA

HIPPAA Form

Adobe Acrobat Reader