We are committed to provide our members with the highest quality of 21st century primary care service. The Institute will create a ' healthcare team' around your medical needs that focuses on you having control over your health.
To do this, we need 6 forms: 1) "Authorization of Release of Information"; 2) "HIPPA Notice of Privacy"; 3) "Patient Agreement"; 4) "Patient Demographics"; 5) "Patient Portal Registration"; 6) "Release of Billing Information". Please click on the buttons below to view these forms. Please print each of the forms, complete, and submit them to our office for review. We will immediately contact you if more information is needed, and schedule a 45 to 60 minute initial appointment at your convenience to create your personalized optimal health plan.
Thank you for your interest in becoming a new patient of the Emerald Coast Health Institute. We are committed to you. If you have any questions regarding the above process, please contact our office. Someone will be glad to assist you.