Now accepting Telehealth appointments. Schedule a virtual visit.

Patient Forms


 

Authorization Form – This form is used to confirm the direction of an individual that we use or disclose protected health information for a particular purpose.
  Download the Authorization Form

Medical Information Release Form – Florida law requires that information contained in medical records be held in strict confidence and not be released without your written authorization.
  Download the Consent Release of Medical Information

Guarantor Statement – Upon check in, we will collect your copay, uncovered services or percent of your financial responsibility as determined by your insurance.
  Download the Guarantor Statement

Medications During Pregnancy – Congratulations on your new pregnancy! We are very glad you have chosen us for your prenatal care. Helping you enjoy a happy, healthy pregnancy is our primary concern.
» Download the Medications During Pregnancy Form

Patient Demographic Sheet
  Download the Patient Demographic Sheet

Location
Christopher K Quinsey, MD
2500 West Lake Mary Blvd, Suite 204
Lake Mary, FL 32746
Phone: 407-537-9001
Fax: 407-688-9229
Office Hours

Get in touch

407-537-9001