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727-SURGERY 941-SURGERY
Call Us Now
727-787-4379
941-787-4379
Fax: 727-228-4542
Make an
Appointment

Administrative/Doctor’s Office Visit

To make your first appointment as productive as possible please bring the following items with you:
A list of your current medications and dosages. You may bring the bottles or containers with you to your first appointment.

Medical information, radiology images, reports, and records supplied by your local doctor,
The name, address and telephone number of the doctor who referred you, if applicable.

Written authorization of referral from your HMO or PPO, if you are covered by one of these organizations.
Your insurance information, insurance card, photo id.

Bring your pharmacy name, address, city, state and ZIP code for any prescriptions you may need to fill.
Items to help pass the time while you wait for your appointment.

A copy of your guardianship, living will, or other advance directive form for your doctor to review. It will then be placed in your medical record.

You, your legal representative or your care provider has the right to request a chaperone during your examination or treatment.

Please be sure to follow any special instructions, such as fasting, that you may have received.

Bring completed new patient forms with you. You can download and print the forms here.
Please bring in a form of payment for your visit i.e deductible, copay, coinsurance, self-pay. We accept all major credit cards, debit cards, personal checks, and money orders.