New Patient Forms
Is the new patient under 12 years of age? If yes, please use button below to access Child New Patient From. If no, please move on to next question.
Child New Patient Form
Parents and guardians can view and print our Child New Patient Form found on the link below. Please bring the completed form for your including a valid License/ID and insurance information, if applicable, to your childs’ appointment.
Is your chief complaint related a recent auto accident within the past 14 days? If yes, please use button below to access PIP New Patient From. If no, please move on to Final Form.
PIP/Auto Injury New Patient Form
Please view and print our PIP/Auto Accident New Patient Form on the link below. Bring the completed form, a valid License/ID, Auto and Health insurance cards to your appointment.
If questions 1 & 2 did not apply, please complete the New Patient Form below.
New Patient Form
Please view and print our New Patient Form at the link below. Bring the completed form, a valid License/ID and insurance card, if applicable, to your appointment.
Get In Touch With Us Today
If you would like to visit our office in Clermont, Florida and become a new patient please schedule by calling our office at 352-242-2560, or fill out the form below and a member of our staff will reach out to you shortly.
We’d love to discuss the first step in your journey to optimal health!