Patient Forms

The physicians and staff at Family Medical Centers look forward to assisting you with your healthcare needs. It is our intention to make your visit as pleasant and convenient as possible. To reduce wait time and facilitate your appointment at any of our 11 area locations, we’ve provided these important forms online for your convenience.

Please review the following information, print forms and bring them with you to your next appointment.

Instructions: Please review, sign and bring to your first appointment.

Download Form

Instructions: Please fill-out and bring to your first appointment.

Download Form

This document covers our payment policies and will need to be read and signed upon your first visit.

Download Form

This notice describes how medical information about you may be used and disclosed and how you can obtain access to this information. Please review it carefully.

Download Form

Insurance Plans Accepted

  • Aetna (HMO & PPO)
  • AARP
  • AvMed
  • Beechstreet Health Plans
  • Cigna
  • Coventry
  • Evolutions Healthcare
  • Florida Blue
  • Gator Group
  • GENEX / Choice Provider Network
  • GHI
  • Heritage Summit
  • Medicaid
  • Medicare
  • Medicare Railroad
  • Molina
  • Multiplan
  • PHCS
  • Care Plus (Duval County locations only)
  • PUP Medicare
  • Rockport
  • Secure Horizons
  • Simply Healthcare
  • Tricare
  • United Healthcare Medicare
  • Wellcare
  • Worker’s Compensation
Please Note: Insurance plans are subject to change.