Patient Intake
Be sure to carefully read and follow all the instructions below.
Complete our online Patient Intake forms by clicking any header or button.
Be sure to complete all fields marked with a star. Be sure to have your license and proof of condition ready to upload!
BEFORE YOU BEGIN THE PATIENT INTAKE FORMS | Be prepared to upload a photo of your Florida drivers license and your Proof of Condition (medical records diagnosis).
DO NOT SUBMIT A DOCUMENT THAT IS NOT READABLE OR TOO SMALL TO VIEW.
ACCEPTABLE FORMATS: jpg, gif, png
After your forms are submitted, a Schedule Appointment button will appear on the same page.
Need help? Text us at 813.774.3474
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