Patient Forms

General Forms & Information

• File

  Patient Bill of Rights
• File

  Post-Operative Instructions
• File

  Non Discrimination Notice
• File

  Non Discrimination Notice (Spanish)
• File

  Advanced Directives
• File

  Disclosure for Out-of-Network Benefits
• File

  Patient Disclosure of Information
• 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 Verification Form
• File

  Financial Responsibility Acknowledgement

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

US Anesthesia Partners (USAP)
851 Trafalgar Ct Ste 200E
Maitland, FL 32751
(888) 339-8727

Advent Health OP Labs
2501 N Orange Ave ste 370
Orlando, FL 32804
(407) 303-8561

Ameripath – Central Florida
745 Orienta Ave Ste 1201
Altamonte Springs, FL 32701
(800) 561-6991