Online Forms

If you are unable to print the required forms, please click the link below to fill this one out online.

Online Form

Downloadable/Printable Forms

New Patient History
Protected Health Information Form

While we accept most commercial insurances, please contact us to find out if your individual plan is covered.

Accepted Insurance Plans:
  • Aetna
  • Ambetter
  • AvMed
  • Blue Cross Blue Shield (we do not accept Florida Blue – My Blue)
  • Careplus
  • Cigna (we do not accept Local Plus)
  • Cigna Health Springs
  • ChampVA
  • Florida Health Care (Triple Options, POS, & HMO)
  • Freedom Health | Optum
  • Golden Rule
  • GEHA
  • Health Ease
  • Health First | Advent
  • Humana (PPO, POS. EPO, Medicaid. Humana Gold only accepted in Okeechobee location)
  • Medicaid (most plans)
  • Medicare B
  • Meritain Health
  • Most Secondary Insurances
  • PHCS | Multiplan
  • Railroad Medicare
  • Staywell (not accepted in Winter Park location)
  • Tricare (Standard & Prime. Referral and prior authorization required for Prime)
  • Tricare for Life
  • UMR (Choice, Choice Plus, & Core)
  • United Healthcare (PPO, Medicaid, Dual Complete & Golden Rule)
  • VA (referral and prior authorization required)
  • Wellcare (not accepted in Winter Park location)
Not Accepted Insurance Plans:
  • Allegiance
  • Amerigroup
  • Cigna – Local Plus
  • Emblem Health
  • First Health Choice
  • Florida Blue – My Blue
  • Florida Health Care – Medicare Plans
  • GHI
  • Healthsmart
  • Magellan Medicaid
  • Molina
  • Oscar
  • Staywell Healthy Kids
  • Sunshine Health Kids
  • UMR – Orlando Health Network