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Due to unforeseen lease circumstances, our Apokpa Office has closed. Apopka patients, please contact our Orlando Office to reschedule.
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New Patient Forms

new patients

During the first visit, we make sure to obtain important background information, like your medical history, and give you time to get to know your doctor.  We accept most insurances.

Patient Forms
Please print and fill out the New Patient forms so we can expedite your first visit.

pdf downloadApopka New Patients Form

pdf downloadDeBary New Patients Form

pdf downloadLake Mary New Patients Form

pdf downloadOrlando New Patients Form

pdf downloadOviedo New Patients Form

pdf downloadHIPAA Privacy

Please arrive early so that we can complete your initial paperwork. Also, please bring the following:

  • Patient's insurance card
  • List of current prescriptions and/or over-the-counter medication, including dose and frequency
  • Information about patient's medical and surgical history
  • Recent test results, x-rays, or relevant records

Insurance and Payment Information

You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please call our office in Apopka (407) 889-2262 Dr. Alaish, DeBary (386) 668-2663 Dr. Roth and Dr. Watson, Lake Mary (407) 323-2566 Dr. Roth and Dr. Watson, Orlando (407) 281-1414 Dr. Alaish, Oviedo (407) 679-7444 Dr. Chessman or Oviedo (321) 750-6599 Dr. Sanchez-Robles. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

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