Auto Injury Patients

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Patient Information

To better serve you and our other patients, we ask that you complete the forms listed below in their entirety prior to your first appointment.

Auto Accident Check In

Registration Form

Medication Patient Sheet

Medical and Financial Consent Form

Standard Disclosure

Medical Release Form

Doctor’s Lien

Patient Authorization

Patient Personal Injury Protection Acknowledgement

Please bring these items to your scheduled appointment:

  • Insurance card — auto and health, if applicable
  • Picture identification (accepted forms of ID include: driver’s license, state ID card, student ID, or passport)
  • Medication bottles from your current prescriptions
  • Medical records, including MRI reports, X-rays, laboratory tests and office notes from other medical facilities where you have received treatment. (These are a critical part of the evaluation.)
  • Auto policy declaration page and ID

You will also need to provide the following information for your visit:

  • Assigned accident claim number from YOUR auto insurance carrier*
  • Date of accident (as listed on the police report)
  • Copy of police or accident report

*Florida is a NO-FAULT state. You must report any accident to YOUR insurance company.