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Cocoa Beach (321) 784 5437
Melbourne (321) 724 5437
Rockledge (321) 636 3066
Palm Bay (321) 327 8773

Forms & Policies

Patient Forms

Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility
All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento
Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos
This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.

ADHD Forms

Anxiety Forms

Depression Forms

Sports Participation Forms

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