{"id":1081,"date":"2021-10-11T14:17:27","date_gmt":"2021-10-11T14:17:27","guid":{"rendered":"https:\/\/www.toplinemd.com\/southlakeobgyn\/?page_id=1081"},"modified":"2021-11-04T10:08:57","modified_gmt":"2021-11-04T10:08:57","slug":"the-patient-zone","status":"publish","type":"page","link":"https:\/\/www.toplinemd.com\/southlakeobgyn\/the-patient-zone\/","title":{"rendered":"Patient Forms"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1331.2px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:30px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1\"><h1>The Patient Zone<\/h1>\n<\/div><div class=\"fusion-image-element \" style=\"--awb-margin-bottom:20px;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-1 hover-type-none\"><img decoding=\"async\" width=\"900\" height=\"467\" title=\"the-patient-zone\" src=\"https:\/\/www.toplinemd.com\/southlakeobgyn\/wp-content\/uploads\/sites\/215\/2021\/10\/the-patient-zone.jpg\" alt class=\"img-responsive wp-image-1082\" srcset=\"https:\/\/www.toplinemd.com\/southlakeobgyn\/wp-content\/uploads\/sites\/215\/2021\/10\/the-patient-zone-200x104.jpg 200w, https:\/\/www.toplinemd.com\/southlakeobgyn\/wp-content\/uploads\/sites\/215\/2021\/10\/the-patient-zone-400x208.jpg 400w, https:\/\/www.toplinemd.com\/southlakeobgyn\/wp-content\/uploads\/sites\/215\/2021\/10\/the-patient-zone-600x311.jpg 600w, https:\/\/www.toplinemd.com\/southlakeobgyn\/wp-content\/uploads\/sites\/215\/2021\/10\/the-patient-zone-800x415.jpg 800w, https:\/\/www.toplinemd.com\/southlakeobgyn\/wp-content\/uploads\/sites\/215\/2021\/10\/the-patient-zone.jpg 900w\" sizes=\"(max-width: 1024px) 100vw, (max-width: 640px) 100vw, 900px\" \/><\/span><\/div><div class=\"fusion-text fusion-text-2\"><p>We would like to take this opportunity to welcome you as a new patient to our practice. In order to help your first appointment run smoothly we have provided a link below that will allow you to print all the new patient forms you will need to have filled out <u>prior<\/u> to your first visit with us at South Lake Obgyn Clermont, FL.<\/p>\n<ul>\n<li><strong><a href=\"\/southlakeobgyn\/wp-content\/uploads\/sites\/215\/2021\/10\/NEW-PATIENT-REGISTRATION.pdf\" target=\"_blank\" rel=\"noopener\">New Patient Registration<\/a><\/strong><\/li>\n<li><strong><a href=\"\/southlakeobgyn\/wp-content\/uploads\/sites\/215\/2021\/10\/MEDICAL-HISTORY.pdf\" target=\"_blank\" rel=\"noopener\">Medical History<\/a><\/strong><\/li>\n<li><strong><a href=\"\/southlakeobgyn\/wp-content\/uploads\/sites\/215\/2021\/10\/CONSENT-FORMS-1-3.pdf\" target=\"_blank\" rel=\"noopener\">Consents (including HIPPA)<\/a><\/strong><\/li>\n<li><strong><a href=\"\/southlakeobgyn\/wp-content\/uploads\/sites\/215\/2021\/10\/PRIVACY-POLICY.pdf\" target=\"_blank\" rel=\"noopener\">Privacy Policy<\/a><\/strong><\/li>\n<li><strong><a href=\"\/southlakeobgyn\/wp-content\/uploads\/sites\/215\/2021\/10\/NOTICE-OF-PRIVACY-ACKNOWLEDGEMENT-FORM.pdf\" target=\"_blank\" rel=\"noopener\">Notice of Privacy Acknowledgment Form<\/a><\/strong><\/li>\n<li><strong><a href=\"\/southlakeobgyn\/wp-content\/uploads\/sites\/215\/2021\/10\/MEDICAL-RELEASE-FORM-2015-1.pdf\" target=\"_blank\" rel=\"noopener\">Medical Information Release Request<\/a><\/strong><\/li>\n<li><strong><a href=\"\/southlakeobgyn\/wp-content\/uploads\/sites\/215\/2021\/10\/OFFICE-FINANCIAL-POLICY.pdf\" target=\"_blank\" rel=\"noopener\">Office Financial Policy<\/a><\/strong><\/li>\n<li><strong><a href=\"\/southlakeobgyn\/wp-content\/uploads\/sites\/215\/2021\/10\/PHOTO-AND-VIDEO-RELEASE-FORM.pdf\" target=\"_blank\" rel=\"noopener\">Photo and Video Release (if requested)<\/a><\/strong><\/li>\n<li><strong><a href=\"\/southlakeobgyn\/wp-content\/uploads\/sites\/215\/2021\/10\/FMLA.pdf\" target=\"_blank\" rel=\"noopener\">Family and Medical Leave Act (FMLA)<\/a><\/strong><\/li>\n<\/ul>\n<p>Some of this information will be very sensitive, but necessary in order to fully care for you as our patient. Your privacy is of the utmost importance to us, and we appreciate your honesty in sharing your history with us.<\/p>\n<p>By completing these forms prior to your appointment this will allow our staff and doctors to serve you in a more efficient manner. Please be here 15 minutes before your scheduled appointment.<\/p>\n<p>We will need your insurance card and a photo I.D. at the time of your appointment. Please also remember, you are responsible for your co-pays and any deductibles at the time of your visit. If you are under 18 we require a parent or legal guardian to be present with you at the time of your first visit.<\/p>\n<p>Please be informed that we have a <strong>strict policy<\/strong> on our cancellations or no show appointments. You must give 24-hour notice on all cancellations, or there will be a fee assessed of $75.00 to your account. No show appointments are automatically assessed a fee of $75.00. We have a 24-hour answering system that allows you to contact us when we are not in the <a href=\"https:\/\/www.facebook.com\/southlake.obgyn\/\" target=\"_blank\" rel=\"noopener\">office<\/a>. You may also schedule or cancel your appointment on line 24 hours a day.<\/p>\n<h2>Cancel An Appointment<\/h2>\n<p>Thank you for allowing us to participate in your health care. We look forward to caring for you in the near future at South Lake Obgyn Clermont, FL!<\/p>\n<p>God Bless<\/p>\n<\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":13,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-1081","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.toplinemd.com\/southlakeobgyn\/wp-json\/wp\/v2\/pages\/1081","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.toplinemd.com\/southlakeobgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.toplinemd.com\/southlakeobgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.toplinemd.com\/southlakeobgyn\/wp-json\/wp\/v2\/users\/13"}],"replies":[{"embeddable":true,"href":"https:\/\/www.toplinemd.com\/southlakeobgyn\/wp-json\/wp\/v2\/comments?post=1081"}],"version-history":[{"count":0,"href":"https:\/\/www.toplinemd.com\/southlakeobgyn\/wp-json\/wp\/v2\/pages\/1081\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.toplinemd.com\/southlakeobgyn\/wp-json\/wp\/v2\/media?parent=1081"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}