- Visit Check In Page
- Flu Shot Registration Form
- Pneumonia Shot Registration Form

Please download and complete all applicable forms prior to coming for your visit.
New Patient Forms   Acute Care Work-In   Travel Vaccine Forms

Patient History

Release of Information

Medication List

Privacy Practices
(if new to practice)

Acute Care Form

Acute Respiratory Form

Urinary Tract Infection Form
(if new to practice)

Travel Vaccine Questionaire

Vaccine Consent Form

Flu Shot Registration Form (Medicare)

Medicare Wellness Exam

 Visit Check-In Form

ECHC Forms

918 Rolling Acres Road, Suite One, Lady Lake, Florida 32159
Phone: 352-259-1991 | Fax: 352-259-5540 | Email

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