Welcome to your page, here you will find part of all the forms that are used in our office, and can be downloaded using Adobe Reader Program.
To get a free copy of this program click here.

If you are a New Patient and want to schedule an appoinment with us, we will need to obtain all your medical records first, that will help our physician gives you an accurate diagnosis to your problem. In order to do so, please download and sign the form below and fax it to our office at 407-673-1442.

Medical Records Request Form

To schedule an appoinment, please click here.

FORM FOR TREATMENT WITH STRONG PAIN MEDICATION

Just in case your health care requires a treatment with strong pain medication you will need the following form, please download and review it. We will answer all questions at your appointment:

1. Narcotic Agreement Form.

FORMS TO RELEASE INFORMATION

1. Authorization to Release Benefits Information Form.

2. Medical Records Request Form.

FORMS FOR NEW PATIENTS

1. Treatment Attestation for Pain Management Services.

2. New Patient Information Form.

3. Medical Questionnaire Form.

4. Pain Diagram Form.

5. Notice of Privacy Practices Form.

6. Assignment of Benefits Form.

OTHER FORMS USED BY CFPRC

1. Follow Up Form.

2. Office Policy and Procedures Form.

3. Consent for Injections Form.

4. Patient Consent and Agreement for "Off-Label" Pain Treatment Form.

IN CFPRC, OUR PATIENTS ARE THE MOST IMPORTANT BECAUSE THANKS TO THEM WE HAVE GROWN.
WE WANT TO OFFER A HIGH QUALITY SERVICE, SO IF YOU HAVE ANY DOUBTS, PLEASE CALL US AND WE WILL BE GLAD TO HELP YOU.