North Florida Multispecialty Physicians
North Florida Multispecialty Physicians                                     

Patient Forms

Want to save time during your visit with us? Please print and fill out the following forms and bring with you on your first appointment.

Don't forget to bring your insurance card and a picture id with you. 

In order to register and treat you promptly, we request that our patients bring their current medications with them to each appointment.  Make sure to bring the medications in their original bottles so that we can accurately document dosage and prescribers directions. 

We accept most types of health insurance. Please contact us for further details.

HIPAA Form
HIPAA Form.docx
Microsoft Word document [21.4 KB]
NOTICE OF PATIENT PRIVACY PRACTICES
NOTICE OF PATIENT PRIVACY PRACTICES.docx
Microsoft Word document [22.4 KB]
New Patient Paperwork
New Patient Paperwork.docx
Microsoft Word document [88.5 KB]
New Venous Patient History Form
New Venous Patient Health Form.docx
Microsoft Word document [19.3 KB]
Auth for Release of Records
HEALTHCARE STATUS AUTHORIZATION.docx
Microsoft Word document [13.3 KB]

Important telephone numbers for in case of emergencies:

Emergency Services & Fire Department 911
Centers for Disease Control and Prevention

800-CDC-INFO

(800-232-4636)

Memorial Hospital (904) 391-6111
St. Vincents Southside Hospital (904) 296-3700
Baptist Downtown (904) 202-8000

Call us today to schedule an appointment!

North Florida Multispecialty Physicians Cardiology & Vein Clinic.

8245 Bayberry Road

Jacksonville, FL  32256

 

Ph:  (904) 296-7775

Fax:  (904) 296-7760

referrals.ecc@gmail.com

 

Or use our contact form.

Office Hours

We are open Monday thru Thursday - 8:00am to 4:30pm

Fridays 8:00am to 1:00pm

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