New Patient Forms

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.

Apopka New Patients Form

DeBary New Patients Form

Lake Mary New Patients Form

Orlando New Patients Form

Oviedo New Patients Form

HIPAA 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.