Patient Forms

Authorization to Release Medical Info

HIPAA 1 of 2

HIPAA 2 of 2

PATIENT PORTAL AUTHORIZATION FORM

Adult Health History

Pediatric Health History

One Response to Patient Forms

  1. Ardiana says:

    Instructions for Patient Portal Accounts:

    An account is created in our office once the patient signs the portal agreement.

    An Email Address is used in order to inform the patient that there is a message in the account.

    Once the agreement is signed and the patient provides the email address in the office, our staff will create an account for the patient.

    The patient will then get a welcome email in the email address provided which you will click on a link and create an account with the user name provided and password that the patient must create.

    Due to the security of the system, we do not have access of the patient’s user name or passwords.

    **Do not leave the welcome message in the email inbox for a long time because the account will be deactivated.

    If the user name or password is ever forgotten, the patient can reset the password on the site. If still unable to get into the site, call our office at 352-404-8961 so that staff can reset the account and the entire process starts over.

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