If you are a new patient to Mid Florida Endocrine, please bring the following documents and information with you to your appointment:
Click the link below to download and print all the forms required by Mid Florida Endocrine for each patient. Please bring these completed forms to you on your first visit along with the documents above.
If your insurance company requires a referral to see you a specialist, it is your responsibility to obtain this. If you do not have one for your appointment, and it is required by your medical plan, then you will need to reschedule to a time you have this available.
We participate with many insurance plans. To confirm that we are participating with your insurance plan, please contact your health plan using the phone number on your insurance card for members. We will collect, at the time of your visit, any co-payments, co-insurance or unmet deductibles, along with any outstanding balances you may owe. We accept cash, personal checks and all major credit and debit cards.
Notification less than 24 hours prior to your appointment of your intention to cancel will incur a $25.00 fee. If you No Show or Same Day Cancel, the fee will apply. No exceptions! If you arrive more than 15 minutes after your scheduled appointment time, you may be asked to reschedule.
Prescriptions and all refills are issued during the time of your office visit. Please assess any refill needs prior to coming in to the office. Refill requests made outside of your scheduled appointment will be subject to a 48 hour waiting period and/or a return visit.
Please be advised that if your insurance company requires prior-authorization for your medications, YOU will be responsible for contacting them and having them fax us the proper paperwork. We will not make exceptions.
In order to have an optimal office visit, you will need to have your required lab work done one week prior to your visit. If you fail to do so, please reschedule your appointment.
Please let us know if you change:
Failure to provide your correct insurance information at the time of your appointment will result in you being responsible for the cost of the visit.