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Patient Information

Hospital Affiliations
Your First Appointment | Patient Forms
Exam Prep Instructions | Other Forms | Diets
Insurance and Payment Information | Privacy Practices

Hospital Affiliations

• HCA Florida Lake Monroe Hospital
  1401 W. Seminole Blvd.
  Sanford, FL 32771

Your First Appointment

Please bring the following:

• Patient's insurance card
• List of current prescriptions and/or over-the-counter medication, including dose and frequency
• Information about patient's medical and surgical history
• Recent test results, bloodwork, x-rays (please do not bring films or CDs, only paper reports), or relevant records

Patient Forms

You may fill these forms out at your convenience, but please do not forget to bring them on the day of your appointment or you will have to fill them out again.
[PDF Help]

• Patient Registration Form (PDF)
• Consent for Treatment/Release of confidential information (PDF)
• Financial Policy (PDF)
• Medical History Form (PDF)
• Medical Records Release Form (PDF)

Exam Prep Instructions

!PLEASE NOTE!: YOUR FIRST VISIT WITH OUR PRACTICE IS AN OFFICE VISIT WITH THE DOCTOR. PROCEDURES ARE SCHEDULED SEPARATELY SO PLEASE DO NOT PREP. INSTRUCTIONS ARE FOR PATIENTS THAT HAVE ALREADY BEEN SCHEDULED FOR THEIR PROCEDURE.

[PDF Help]

• Miralax (PDF)
• Trilyte, Colyte, Nulytely, Golyte (PDF)
• Upper GI Endoscopy (PDF)

Diets

• High Fiber Diet

• Low Residue Diet

Insurance and Payment Information

Mid-Florida Gastroenterology Group is a provider for Medicare and most major insurance plans, and provides insurance billing. You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please contact us. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

Privacy Practices

Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. A copy is available upon request. You may also download and view our Notice of Privacy Practice using the link below.

[PDF Help]

• Notice of Privacy Practices, Effective 9/23/13 (PDF)

This is where you can feature something special about the practice, highlight a new service, link to a news article, etc.

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This is where you can feature something special about the practice, highlight a new service, link to a news article, etc.