Insurance List & Forms

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Use the form below to contact us for general information only or offer your comment. Please do not use this form to request appointments, as this mailbox is not monitored constantly.  Most medical advice cannot be given through this contact box and will go unanswered.

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In-Network Service

Uninsured and self-pay is always an option with us.  We have some of the most affordable rates in our area.  The following are insurance carriers that we are in network with:

• Medicare Part B and Part B Supplement Plans (Medicare Advantage plans only if listed below)
• Straight Florida Medicaid (additional managed care plans listed below)
• Vivida Health Medicaid
• CMS (Children's Medical Services Health Plan)
• WellCare Medicare Advantage
• Staywell Medicaid & Staywell Florida Healthy Kids
• Molina Medicaid & Molina Florida KidCare
• Molina Medicare Advantage, Medicare Options & Medicare Options Plus
• Sunshine Medicaid & Sunshine Healthy Kids
• Sunshine Allwell Medicare Advantage
• Sunshine Ambetter
• Blue Cross Blue Shield:
  • Florida Blue PPC/PPO
  • Network Blue PPO
  • Florida Blue Medicare Advantage 65
  • Florida Blue Medicare Advantage PPO
  • We do NOT take Blue Select/HMO
  • If you have out of state BCBS with PPO and a small suitcase emblem on your card you are in network with us
• United Healthcare HMO/PPO (NO Medicare Select or Advantage)
• Cigna (PPO, HMO, Open Access)
• Tricare (Humana Military)
• HUMANA:
  • Humana Medicaid
  • Humana HMO, PPO, EPO, POS
  • Humana Medicare Advantage PPO/PFFS (no HMO)
  • Choicecare Medicare Advantage PPO, PFFS (no HMO)
  • Choicecare PPO
• Evolutions Healthcare Prime, Select, Choice, and International Networks
• Liberty Healthshare
• MultiPlan Network, PHCS, PHCS Savility
• CareCredit
• Cash and all major credit cards accepted

Patient Forms

Please click the links below to download our forms.  If you do not wish to fill them out in advance, please be sure to arrive at least 15 minutes early to your first appointment.

Email Authorization

New Patient Forms - English

Formas de Pacientes Nuevos - Espanol