New Patient Information

New Patient Information
New Patient Information2019-01-29T16:19:19+00:00

If you would like to schedule a new patient Appointment, or have questions about our office, please call (239) 985-1925.

If you have already booked an appointment:

• Please arrive 30 minutes early to ensure the appropriate amount of time to register.
• Please bring a form of photo identification and your insurance card(s).
• Please provide a list of any medications you are currently taking and provide it to the front desk when you arrive.

Please fill out the attached forms and bring them to your first visit.

Patient Registration Forms

If you are seeing Dr. Tolep for your first visit, please also complete the following:

Patient Medical History Form – Dr. Tolep

If you are seeing Dr. Sareh for your first visit, please also complete the following:

Patient Medical History Form – Dr. Sareh

Services

CONTACT REQUEST FORM

This form is for potential new patients only. If you are an existing patient, please use the patient portal. Please don't share any medical information on this form. We will contact you to gather more information. Thank you.

Schedule Appointment or Call: (239) 985-1925

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