Patient Forms

Please print, sign, and bring the following forms with you on the day of your surgical procedure. If you have any questions regarding the forms and/or their content, please feel free to contact us at 813-972-4905, option 3, then option 5. Completing these forms prior to your appointment will assist the patient with a smooth and efficient check-in process.


  1. Advance Directives
  2. Assignment of Benefits
  3. Designated Individuals Authorization
  4. HIPAA Consent Form
  5. Notice of Disclosure of Financial Interest for the FOIASC
  6. Patient Bill of Rights