New Patient - First Visit

"The Doctor Will See You Now.”

Office in Dundee, Florida 28055 US-27, Dundee, FL 33838

New Patient Intake Forms

The following intake forms can be printed and filled out prior to your initial appointment:

  • HEALTH HISTORY FORM
  • CONSENT TO TREAT AND POLICIES FORM
  • PAYMENT AGREEMENT
  • CONSENT FOR COMMUNICATION
  • PATIENT PRIVACY HIPAA NOTIFICATION

Serving Winter Haven and Greater Polk County!

Located in Dundee, Florida next to WINN-DIXIE at 28055 US-27, Dundee, FL 33838