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New Patients
To help reduce your waiting time, you can print and complete the below forms prior to your office visit. Please bring them with you, rather than mailing or faxing them to us.Please complete all six (6) forms.

1. Patient Registration Fom
2. History and Physical (2 pages)
3. HIPAA consent form
4. Referral Policy
5. Lab Policy
6. Patient Financial Policy

If you need any assistance with these forms please feel free to call (407) 345-0005 X 101 or 105

Your medical records are completely private. To ensure patient confidentiality, and conforming to HIPAA regulations, no information regarding your condition will be released by this office to anyone, including any family member, without your written consent. They are two forms below for the release of medical records.

1. Medical Records Release Form I (if you would like Southwest Internal Medicine to release records to yourself or other parties)
2. Medical Records Release Form II (if you would like Southwest Internal Medicine to recieve your medical records from other healthcare providers)

If you need any assistance with these forms please feel free to call Medical Records (407) 345-0005 X120