Please complete our forms and email or
fax to 239-278-5786
and one of our patient coordinators will get in touch with you!
New Patients
Our new patient paperwork is now available online! Click on the link to the left to download our forms. Please print them out and complete them and then either email or fax them back to us.
Once we receive your completed new patient paperwork, one of our patient coordinators will review your information, verify your insurance, and contact you to make an appointment to see the doctor.
For Workers' Compensation and Auto Accident patients you will need to bring to your appointment:
- Your driver's license or any state issued ID that is current and valid.
- Any medications that you are current prescribed including the medication bottles.
For Commerical Insurance (Aetna, BlueCross/BlueShield, and Cigna) you will need to bring to your appointment:
- A Florida Driver's License or Florida State ID that shows residency here in Lee County. We will not treat out-of-county or out-of-state patients that have commerical insurance.
- Any medications that you are current prescribed including the medication bottles.
For Self Pay patients the cost is $300.00 for the initial evaluation and then follow up visits are $200.00 per visit. This covers the time with the physician and also the urine drug screen that we perform at each visit in accordance with Florida's Department of Health guidelines.
All Self Pay patients must prepay for the initial evaluation prior to be given an appointment. This prepayment is non-refundable and is to ensure that that patient will keep their scheduled appointment. All Self Pay patients will also need to have the medical records forwarded to our office prior to the appointment.
You will need to bring with you at the time of the appointment:
- A Florida Driver's license or Florida State ID that shows residency here in Lee County. We will not treat any out-of-county or out-of-state self pay patients.
- Any medications that you are currently prescribed including the medication bottles.
We do not accept Medicare or Medicaid.