New Patient Paperwork

After calling to schedule your New Patient Appointment please print, complete and this paperwork with you to your appointment along with any insurance (automobile and/or major medical-health) you would like us to verify and your driver’s license. Should you have any questions please do not hesitate to call the office at (321) 499-4608.

COVID 19 Info – We are closely monitoring events in our local community and continuously updating our policies and protocols as a result of new information.  Our highest priority is to keep all of our patients and staff as safe as possible.

• We are scheduling for social distancing. To assist us please arrive only at our appointed time. We ask that only those patients with scheduled appointments enter the office. If you plan to bring a guest, please advise us ahead of time so we make appropriate accommodations.
• We understand that many have been vaccinated and at this time wearing a, bandana or face covering while in the office is voluntary. If at any time you are uncomfortable with this, at the time of your visit please, advise the staff and we will make every effort to accommodate you. 
• If you require special accommodations due to an immune compromised system, please let us know.

Our Address is 490 Centre Lake Drive NE, Suite 100A, Palm Bay, FL  32907.  We are INSIDE the 1^st Centre Building with Med Fast Urgent Care and Florida Pain Institute.

DIRECTIONS:

From Palm Bay Road:

Take Culver. From Culver you will travel south pass DR Horton Homes and our building at 1st Centre as it rounds the corner. You will then pass a patch of trees on your left and immediately after the trees is Centre Lake Drive just before the RV dealership, Giant Recreation World.  Take a LEFT onto Centre Lake Drive and follow it back to the chain link fence.  Take a left into the drive at the chain link fence and follow back to our parking lot.  Enter the building through the double glass doors that face I95. Our office is the 2^nd door on the left, Suite 100A, with the glass window insert.

From Emerson:

Take Emerson to Culver. From Culver you will travel north (at the Senior Center) to the RV dealership, Giant Recreation World. Take a RIGHT at the RV dealership onto Centre Lake Drive and follow it back to the chain link fence. Take a left into the drive at the chain link fence and follow back to our parking lot. Enter the building through the double glass doors that face I95. Our office is the 2nd door on the left, Suite 100A, with the glass window insert.

We look forward to meeting you!

See You Soon!