• 904-337-1111

MEDICAL FORMS

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:

Please bring these items to your scheduled appointment:

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

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:

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.

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:

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)

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:

Please bring these items to your scheduled appointment:

  • Insurance card
  • 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.)

Insurance Plans

Insurance Plans Accepted Product
AARP
Secondary to Medicare only
Aetna (PPO, POS and HMO. No Coventry HMO products)
Referral may be needed
Epilepsy Foundation of N Florida
Referral needed
First Health
Florida Blue
Referral may be needed
Medicare Advantage PPO (No HMO products)
PPC
PPS (traditional)
Network Blue
Blue Select
Health Options
Medicare
Medicare Railroad
Multiplan
One Call Medical
United Health Care (most plans)
**Not UHC Medicare complete
**Not Medicaid
**No Marketplace
Workers Compensation
**Case specific
Auto Insurance
All carriers

**Other Commercial Carriers accepted. Please call to inquire.

We are NOT accepting:
Avmed
Cigna
Humana
Medicaid
Coventry
United Medicare plans
Tricare

Worker’s Comp – Case specific, please call us at (904) 419-6580 or (904) 419-6582

Auto Insurance – We accept ALL carriers, please call us at (904) 419-6564 to verify your coverage

Health Insurance We Accept

All Auto Insurances Accepted

  • AARP
  • Aetna
  • Florida Blue
  • UnitedHealth Group
  • Medicare
  • Medicare
  • Medicare