Patient Forms

New Patients

Indialantic Medical Associates is required by law to maintain the privacy of your protected health information. This information consists of all records related to your health, including demographic information, either created by Indialantic Medical Associates or received by Indialantic Medical Associates from other health care providers.

We are required to provide you with notice of our legal duties and privacy practices with respect to your protected health information. These legal duties and privacy practices are described in this notice. Indialantic Medical Associates will abide by the terms of this notice, or the notice currently in effect at the time of the use or disclosure of your protected health information.

Indialantic Medical Associates reserves the right to change the terms of this notice and to make any new provisions effective for all protected health information that we maintain. Patients will be provided a copy of any revised Notices upon request. An individual may obtain a copy of the current notice from our office at any time.

To help reduce your waiting time, you can print and complete the forms below prior to yours scheduled office visit. Please bring them with you, rather than mailing or faxing them to us.

1. Patient Registration Form
2. HIPPA Consent Form
3. Patient Responsibilities
4. Patient Consent for Communications and/or Disclosure
5. Adult Patient History
6. Pediatric Health History

If you need any assistance with these forms please call us a 321.724.9900. Your medical records are completely confidential. To ensure patient confidentiality, and conforming to HIPPA regulations, no information regarding your condition will be released by this office to anyone, including any family member without your written consent.