New Patient Information

New Patient Information
New Patient Information2020-06-08T14:45:00+00:00

If you are new to our practice and would like to schedule a new patient consultation, please call (239) 985-1925.

If you have already booked an appointment:

• Please arrive 30 minutes early to ensure the appropriate amount of time to register.
• Please bring a form of photo identification and your insurance card(s).
• Please provide a list of any medications you are currently taking and provide it to the front desk when you arrive.

Please fill out the attached forms and bring them to your first visit.

Patient Registration Forms

If you are seeing Dr. Tolep for your first visit, please also complete the following:

Patient Medical History Form – Dr. Tolep

If you are seeing Dr. Sareh for your first visit, please also complete the following:

Patient Medical History Form – Dr. Sareh

Medical Records

To make the most out of your visit, please ensure your current team of physicians send your medical records to PCS prior to your scheduled appointment.  A release form has been provided below for your convenience. You will need to complete one form for each physician you are requesting records from.
Patient Authorization for Disclosure of Health Information

CONTACT REQUEST FORM

This form is for potential new patients only. If you are an existing patient, please use the patient portal. Please don't share any medical information on this form. We will contact you to gather more information. Thank you.


Note: This form is for general inquiries only and is not meant for use by existing patients. If you are a current or previous patient and you need to contact us please call 239-985-1925 between 8 am and 5 pm, Monday through Friday. If you have a medical emergency, please call 911.

Schedule Appointment or Call: (239) 985-1925

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