Download Forms & Links

Print these medical history forms and fill them out before visiting our offices to help expedite your check-in.

If you would like to fax them to us before your appointment, our fax number is 813-891-6889.

Note that these printable forms are in PDF format for your convenience. If you do not have adobe acrobat and would like to download it now, please click Adobe Acrobat Download.

  • genovadiagnostics.com – Advanced nutritional, hormonal, cardiovascular testing
  • 4myheart.com – Advanced genetic and cardiovascular testing
  • spectracell.com – Advanced nutritional and cardiovascular testing
  • alcat.com – Advanced allergy testing
  • familydoctor.org – We use this link for patient information, there are hundreds of handouts
  • D1sportstraining.com – Elite sports and fitness training from youth to adults. Since 2002 they have trained 15,000 scholastic athletes, and 500 division I collegiate athletes, and thousands of adult executives.
    The circuit city building in citrus park mall has been converted to a medical and fitness center. The next Patients First office, as well as D-1’s 18,000 square foot gym, physical therapy center, and the orthopedic surgeon offices of Drs Chris Maclaren and Kevin Scott will open in December 2011
  • westchasepharmacy.com – We have worked very closely with the Westchase compounding pharmacists over the last 7 years for a team centered approach in health care for our patients. They have helped us with everything from bioidentical hormone balancing to flavoring children’s liquid antibiotics
  • christinemiller.meta-ehealth.com – Christine is the best nutritionist that I have been able to find in Tampa Bay. Her office is in Westchase, and she has helped hundreds of our patients to improve their medical challenges by a more focused effort into changing their dietary habits
  • townandcountryhospital.com – 200 bed private community hospital in the Town&Country area of Tampa. They offer a host of unique services, as well as a fully capable ER, and all of their rooms are private rooms
  • Patients First Facebook Page – We are also on facebook! please feel free to visit us for more updates.


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Patients Portal

Appointment Request
For established patients only.
*Name:

*Email:

*Phone:

*Reason for appointment:

*DOB:

*Provider:

*Date Requested:

Time Requested:

Comments:
*Required Field
Prescription Refills
3 days are required to process refill requests!
If multiple refills needed, please use separate requests.
*Name:

*Email:

*Phone:

*DOB:

*Medication name, dose, and frequency taken:

30 day or 90 day refills?
30 Day 90 day
*Pharmacy name:

*Pharmacy phone:

Comments:

*Required Field
Referrals
*Name:

*Email:

*Phone:

*Date of birth:

*Reason for referral:

*Specialist name and specialty:

*Specialist phone:

*Specialist fax:

*Date of appointment:

*Insurance company:

*Insurance group number:

*Policy number:

*Required Field
Billing
*Patients Name:

*Email:

*Date of birth:

*Contact number:

Questions:
*Required Field
Questions/Comments
*Name:

*Email:

*Contact number:

Question:
*Required Field