Patient Registration Form

New patient packet that includes registration form as well as history and physical form.

Notice of Privacy Practices

The HIPAA Privacy Rule requires health plans and covered health care providers to develop and distribute a notice that provides a clear, user friendly explanation of individuals rights with respect to their personal health information and the privacy practices of health plans and health care providers.

Records Request

Need a copy of your records sent to you or another provider? Simply fill out this form and drop it off at our office, fax it to 850-479-6247, or mail it.

Right to Inspect Form

The Privacy Rule gives you, with few exceptions, the right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the Privacy Rule.

Only you or your personal representative has the right to access your records.

A health care provider or health plan may send copies of your records to another provider or health plan only as needed for treatment or payment or with your permission.

The Privacy Rule does not require the health care provider or health plan to share information with other providers or plans.

HIPAA gives you important rights to access your medical record and to keep your information private.

 

A provider cannot deny you a copy of your records because you have not paid for the services you have received. However, a provider may charge for the reasonable costs for copying and mailing the records. The provider cannot charge you a fee for searching for or retrieving your records.

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Contact us!​

 

2201 E Nine Mile Rd

Pensacola, FL 32514

 

Telephone : 850-479-6250

Fax : 850-479-6247
Email : info@FeetAreNeat.com

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Hospital Affiliations

Andrews Institute Ambulatory Surgery Center

Sacred Heart Hospital

West Florida Hospital