New Patient Form

We are delighted that you have scheduled an appointment with Pulmonary Associates of Brandon/Florida Sleep Disorder Center. We are honored to participate in your health care. To help ensure you have the best possible visit, we offer a few tips:

1. Please completely fill out the required paperwork prior to your arrival for your first appointment. If you have completed all the requested paperwork prior to your appointment, you should plan to arrive at least 15 minutes prior to your scheduled appointment time. If you are unable to complete the required paperwork prior to your appointment, you must arrive at least 30 minutes prior to your scheduled time. We know that sounds like a long time, but your providers want to have as much information about you as needed to provide you with exceptional medical care.

2. Please bring a list of all current medications or complete list of all prescription and over-the-counter medications you are taking, along with the dose and frequency.

3. Please bring your insurance card(s) and photo identification. We are required to verify the identity and insurance eligibility of all our patients. We are also required to collect any co-payments and/or deductibles at the time services are provided.

4. Bring cash, check or credit card for you co-payment or deductible. If you are unable to keep your appointment for any reason, please notify us at least 24 hours in advance to avoid a missed appointment fee. Should any questions or concerns arise before your next visit with us, please feel free to contact our office at (813) 681-4413. We are available Monday through Friday from 8:00am-5:00pm in the office and through our answering service after hours.

Please complete the following paperwork prior to your appointment. All patients must complete Pages 2-5. Complete Page 6 if you are a pulmonary patient. Complete Pages 7-8 if you are a sleep patient. If you are a combined pulmonary/sleep patient, complete all pages in the packet.