• Main Number: 904-448-4180    Fax: 904-448-4184

MEDICAL FORMS

MEDICAL PATIENTS FORMS

In order to provide a proper and thorough evaluation, we ask that you complete the forms listed below 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)
  • Medicine 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.)
Diagnostic Testing Patients

In order to provide a proper and thorough evaluation, we ask that you complete the forms listed below 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)
  • Medicine 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.)
Auto Accident Patients

In order to provide a proper and thorough evaluation, we ask that you complete the forms listed below 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 injuries to YOUR insurance company.

Pain Management Patients

In order to provide a proper and thorough evaluation, we ask that you complete the forms listed below 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 injuries to YOUR insurance company.

In order to provide a proper and thorough evaluation, we ask that you complete the forms listed below 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 injuries to YOUR insurance company.

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 - Plan only taken by Dr. Goel
Referral may be needed
  • Medicare Advantage PPO (No HMO products)
  • PPC
  • PPS (traditional)
  • Network Blue
  • Blue Select
  • Health Options
  • Medicare
    Medicare Railroad
    Multiplan
    United Health Care (most plans)
    **No UHC Medicare complete
    **No Medicaid
    **No Marketplace
    Workers Compensation
    **Case specific - Please call us at (904) 337-1111
    Auto Insurance
    All carriers - Please call us at (904) 337-1111 to verify your coverage.
    Insurance Plans Not Accepted
    Avmed
    Cigna
    Humana
    Medicaid
    Coventry
    United Medicare plans
    United Healthcare VA
    United Healthcare oneNet PPO Workers Comp
    Tricare

    AUTO ACCIDENTS

    We are here to help after your auto accident.

    PAIN MANAGMENT

    Find relief for your most severe symotoms.

    NEUROLOGY

    Our team of expert neurologists will help find the root of your pain.

    Immediate/Same Day Appointments for Auto Injuries

    Board Certified
    Physicians

    State of the art Pain Management Facility

    Friendly and
    Experienced Staff

    Auto and medical
    Insurance accepted

    Health Insurance We Accept

    All Auto Insurances Accepted

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