Patient Forms

Want to save time during your visit with us? Please print and fill out the following forms and bring with you on your first appointment.

Don't forget to bring your insurance information with you

In order to register and treat you promptly, we request that our patients bring their current insurance information with them for each visit, along with a photo identification and any referal or other information. Please inform the office of any change in address, insurance status or name as soon as possible to ensure payment.

Patient Registration Form English
You may type on this and then print it and bring it into the office.
Medical office registration form 2017-1.[...]
Microsoft Word document [672.6 KB]
Forma de Registro del Paciente In Espanol
You may type on this and then print it and bring it into the office.
Medical office registration form 2017 SP[...]
Microsoft Word document [673.8 KB]
Patient History, page 1.pdf
Adobe Acrobat document [13.9 KB]
Patient History, page 2.pdf
Adobe Acrobat document [16.0 KB]
HISTORIA MEDICA PERSONAL IN ESPANOL
Medical History of patient SPANISH.docx
Microsoft Word document [798.8 KB]
HIPPA Authorization Form
HIPPA ENGLISH.docx
Microsoft Word document [793.8 KB]
HIPPA Forma de Concentimiento
In Espanol
HYPPA SPANISH.docx
Microsoft Word document [794.5 KB]
Authorization of Release of Medical Records
Please fill this form out so we can receive medical records from your doctors.
Authorization of Release of Medical Reco[...]
Microsoft Word document [12.5 KB]
Notice about nondiscrimination and accesibility requirements Ocoee
EAF NOD.pdf
Adobe Acrobat document [420.3 KB]

We accept most types of health insurance. Most commercial, Medicare and Medicare Advantage plans. Including Aetna, Blue Cross Blue Shield, Cigna, Humana, Humana Medicare,Well Care. Any other insurance, please contact us for further details.

 

Important telephone numbers for in case of emergencies:

Endocrine Associates of Florida P.A. Ocoee

407-480-4830

Emergency Services & Fire Department 911
Fax 407-480-4834
Research Department 407-480-4836
   

Specializing in

  • Diabetes Mellitus
  • Thyroid Disease
  • Lipid Disorders
  • Metabolic Diseases
  • Nutrition Counseling

 

Ask about out Research Clinic for diabetes and other metabolic disorders

407 480-4836

 

*Please see notice about nondiscrimination and accessibility requirements in patient form

Office Hours

Mon-Thur 8 am to 4:30 pm

Fri 8 am to 3 pm

 

Contact:

Phone (407) 480-4830

Fax (407) 480-4834

Research Clinic (407) 480-4836

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© Endocrine Associates of Florida P.A.. Ocoee