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New Patients

We are so happy you are considering joining our family! Below you will find our new patient admission packet as well as extra medical record release and medication list forms. If you have any questions at all regarding this paperwork and information we may need, please give us a call. 

New Patient Forms

Please fill out this packet as complete as possible before your first appointment. If you are an ALF patient, please turn this in prior to scheduling your first visit. In addition to this packet, please have available copies of your ID and insurance cards as well as any other documentation that may be important to your healthcare.

Medical Record Release

 

Please fill out one of these pages for each specialist and previous Primary Care Provider you have seen. 

Medication List

Please feel free to use additional pages as needed to list any prescription and over the counter medications you take.

Self Pay Agreement

Please fill out this form only if you will be a self pay patient and we will not be filing your insurance.

Insurance We Accept

We currently accept the following insurance. 

Since plans differ, please allow us to verify your benefits 

to let you know for sure if we are in network with your particular plan.  

 

Medicare

  • Traditional Medicare 

  • Wellcare PPO
  • Railroad Medicare
  • We do not accept any Medicare Advantage (HMO) plans

 

Medicaid

  • Traditional Medicaid

  • Sunshine Health

​

Aetna - We do not accept the HMO plans

 

Blue Cross Blue Shield - Out of Network Benefits only

 

United Healthcare  - Out of Network Benefits only  

 

Cigna Commercial Policies

  • We do not accept Cigna Healthspring

 

Tricare

  • Prime

  • Select
  • Tricare For Life
 

Multiplan/PHCS

 

Oscar

(850) 434-0077 | (850) 434-0220

Pensacola, FL 32506

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