This is the registration packet that we have you fill out when you come into the office. Printing the forms and filling them out at home will save time at your appointment.


Please download the forms to your computer. Once downloaded, print and fill them out entirely, signing where indicated.


If you want clarification on anything, please ask when you arrive in our office, and we will answer any questions that you have.

HIPPA Compliance

& Consent



Integrity (in•teg•ri•ty)

the quality of being honest and having

strong moral principles; moral uprightness.

2606 Lakeland Hills Blvd. Lakeland, FL 33805

135 1st Street South, Winter Haven, FL, 33880

Phone: (863) 937-9200 | Fax: (863) 937-9199 

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