Patient Forms

General Forms

• File

  Non Discrimination Notice
• File

  Non Discrimination Notice (Spanish)
• File

  Advanced Directives
• File

  Patient Rights and Responsibility (English)
• File

  Patient Rights and Responsibility (Spanish)
• File

  Disclosure for Out-of-Network Benefits
• File

  Patient Disclosure of Information
• File

  Pre-Anesthesia Assessment
• File

  Right to Receive a Good Faith Estimate of Expected Charges
• File

  Notice Regarding Patient Protections Against Surprise Billing

Florida Transparency Bill

• File

  Financial Policy
• File

  Financial Verification Form

Services may be provided by other healthcare providers who may bill separately.

APS

4919 Memorial Highway, Suite 200 

Tampa, FL 33634 

(866) 631-7005

Quest

500 Plaza Dr.

Secaucus, NJ 07094

(888) 295-2584

LabCorp

PO Box 2240

Burlington, NC 27216

(800) 845-6167