Faculty Practice New Patient Forms
Faculty Practice Locations
Davie Location
Phone: (954) 262-7213
Wilton Manors Location
Phone: (954) 567-5650
Not All Services Are Offered at Every Location
To expedite your appointment, we ask that you print the following new patient forms and bring them with you on the day of your first appointment.
Patient Forms:
- New Patient Information Sheet
- New Patient Information Sheet (Faculty Practice Only)
- Consent and Agreement for Treatment
- Release of Information for Treatment and Health Care Operations
- Notice of Privacy Practices
- HIPAA Notice of Privacy Practices and Acknowledgement of Receipt
- HIPAA Authorization for Use and Disclosure of Information for Educational and Related Purposes
- Addendum for Established Patients Release of Information for Treatment and Health Care Operations