Patient Forms

General Forms

• File

  Advanced Directives
• File

  Non Discrimination Notice - Spanish
• File

  Non Discrimination Notice
• File

  Patient Bill of Rights and Responsibilities
• File

  Patient Disclosure of Information
• File

  Disclosure for Out-of-Network Benefits
• File

  Pre-Anesthesia Assessment
• File

  Right to Receive a Good Faith Estimate of Expected Charges
• File

  Notice Regarding Patient Protections Against Surprise Billing

Florida Transparency Bill

• File

  Financial Policy
• File

  Financial Verification Form

Services may be provided by other healthcare providers who may bill separately.

Anesthesia Professional Services

4919 Memorial Highway, Suite 200

Tampa, FL 33634

Orlando Health (ORMC)

1414 Kuhl Avenue, North Tower

Orlando, FL 32806

PSAP Lab, Inc.

84 W. Jersey St.

Orlando, FL 32806