Patient forms
Patient forms
Save time at check-in by completing your forms before your appointment at our West Palm Beach office.
New Patient Form
Registration, medical history and insurance information for your first visit.
Traveler’s Medical Service Form
Your itinerary, travel style and vaccine history so we can plan the right protection.
HIPAA Authorization
Authorize release of your health information to the people you choose.
Which forms do I need?
- New Patient Form: for every new patient. It covers your contact and insurance information, medical history, medications and allergies.
- Traveler’s Medical Service Form: for travel medicine visits. It tells us your destinations, dates, activities and vaccine history so we can plan your protection.
- HIPAA Authorization: if you want us to share your health information with someone else, such as a family member, caregiver or another provider.
Before your visit
- Download and print the forms that apply to you, then fill them out at home.
- Bring the completed forms, your photo ID, your insurance card and a list of your medications and doses.
- Bring recent records, lab results or imaging reports from other doctors if you have them.
- Travelers: bring any vaccination records, including your yellow card if you have one.
- Already a patient? Use the Patient Portal to message the office and view results.
About the HIPAA Authorization
Federal privacy law (HIPAA) protects your health information. Our office can use it to treat you, bill for your care and run the practice, but many other disclosures (for example, to an employer, an attorney or a family member who isn’t involved in your care) require your written permission. The HIPAA Authorization form gives that permission, lets you choose exactly who may receive your information, and can be revoked in writing at any time.
Please don’t email completed forms. Regular email isn’t a secure way to send health information. Bring forms with you or ask our staff about secure options.
Frequently asked questions
Which forms do I need for my first visit?
New patients should complete the New Patient Form. If you are coming for travel medicine, also complete the Traveler’s Medical Service Form. Use the HIPAA Authorization if you want us to share your health information with someone else, such as a family member.
Can I email my completed forms?
Please don’t. Regular email is not a secure way to send health information. Bring your completed forms to your appointment or ask our staff about secure options.
What should I bring to my appointment?
Your completed forms, a photo ID, your insurance card, a list of your current medications and doses, and any recent records or test results from other doctors. Travelers should also bring vaccination records.
Ready to schedule a visit?
New patients are welcome. Call our office and we’ll find a time that works for you.