PATIENT
FORMS
APPOINTMENTS
For your convenience, we have any office in Leesburg, located within close proximity of Leesburg Regional Medical Center. To schedule an appointment, please call 352-315-1627.
Please bring the following information to your appointment:
On Your First Visit
- Your medical history;
- Your primary care physician’s name and address;
- For your convenience, we have provided new patient forms which you are welcome to complete prior to your first appointment;
- Please plan to arrive at least 15 minutes prior to your first appointment to allow the staff to review and enter your data.
- Please be sure to bring a list of the medications you are currently taking, as well as dosages for each;
- Your insurance cards;
- Any changes in your address, telephone number or insurance carrier.
If, for any reason, you are unable to keep your scheduled appointment, please call us as soon as possible.
PATIENT FORMS
We have the following forms available that you can download,
print, read and fill out at your leisure.
PAYMENT OPTIONS
As is customary in the medical profession, we require payment at the time of your appointment. We will file your insurance claim for these services. Our office staff can assist you with any questions you may have. If you have questions about your insurance plan, please contact your insurance carrier.
We currently participate with a number of insurance providers. We also file claims with private insurance. If your insurance company requires, you may be responsible for any referral, deductible or co-pay fees. If you have any questions about the payment options available to you, please contact our billing office at (352) 315-1627 or use the Contact form.
Click here to see the list of our accepted insurance carriers.
We are not contracted with Managed Care Plans at this time. You may need to contact your Primary Care Physician for participating providers. If you would still like to receive these services, you will be responsible for the entire cost of these services. Our office staff will be glad to discuss fees for non-covered services with you.