Patient Forms

For your convenience please download and fill-out each of these registration materials and bring the completed forms to your appointment.

Altamonte Medical Group - Patient Health Information Release

Altamonte Medical Group - Patient Registration

Altamonte Medical Group - Health History (front)

Altamonte Medical Group - Health History (back)

Altamonte Medical Group - HIPAA Form

Altamonte Medical Group - Financial Policy

Florida Allergy Clinic – HIPAA Form

Florida Allergy Clinic – Patient Registration

Florida Allergy Clinic – Insurance and Billing Information

Florida Allergy Clinic – Financial Policy

Florida Allergy Clinic – Patient Overview

To facilitate the registration process, please be sure to present your photo- identification card and a copy of your current healthcare insurance information to the receptionist when you arrive for your scheduled meeting.


Office Policies

At Altamonte Medical Group, we pride ourselves on providing our patients with the best medical care available, in a comfortable, friendly office setting. The following policies have been designed to ensure efficient operation of the medical practice and to be fair and equitable to all of our patients. Your cooperation with these stated policies enables us to focus our attention on your medical needs to better serve you.



Individual appointment times are reserved especially for you. These sessions may last from 15-45 minutes depending on the complexity of the medical condition to be evaluated. We strive to be prompt and adhere to the established schedule; however given the nature of our practice, we ask your patience and understanding should we be delayed. Be certain that you will receive the same courteous and thorough care as your fellow patients

Please plan to arrive at the clinic at least 15 minutes before your scheduled appointment. If you will be late, we would greatly appreciate a courtesy notification so that we may plan accordingly and readjust our schedule. If you are unexpectedly delayed but within 15 minutes of your allotted time, we will still make every effort to accommodate you, as the schedule permits. If you are more than 15 minutes late, you may be asked to reschedule for the next available appointment time. Emergent cancellations and/or no-shows will be addressed on an individual basis.


Cancellations and No Shows

We require that any cancellation or request for rescheduling of your appointment be made at least 24 hours in advance of the allotted time. If you cancel or change your appointment less than 24 hours before you are expected or simply do not show up for your scheduled appointment without prior notification, than you will be billed a $25.00 fee.

Multiple cancellations, extended delays or failure to show for repeated appointments may result in discharge from this practice. In such cases, your physician will continue to be available to you for a period of 30 days, after which time we can no longer provide treatment, consultation, medication or emergency care. Upon your request and signed authorization, we will forward copies of your medical records to another healthcare provider.


Scheduling Changes

On occasion, some appointments may have to be altered to accommodate unexpected changes in your healthcare provider’s schedule. Every effort is made to minimize this inconvenience, and you will be notified at the earliest possible time that such a change may be necessary. You will always be offered an opportunity to be seen by another physician/physician assistant, or you can reschedule your visit to a different time and/or date that is more convenient for you. We appreciate your understanding.


Prescriptions & Medication Renewals

With few exceptions, prescriptions for medications will only be written, renewed and dispensed during your scheduled office visits. Rarely, your physician may determine that your request for medication warrants attention outside of an office visit. Any and all such requests for medication outside of a scheduled office visit will incur a $10.00 fee for each prescription, charged directly to your account. This includes any request for change of medications due to restrictions or requirements unique to your health insurance/pharmacy benefit plan. This additional request for service will require a minimum of 2 business days to evaluate, review and update your medical record, and to process.


After Hours/ On-Call Consultation

In the event of a medical emergency occurring after office hours, you are instructed to directly contact 911 for immediate care. If you have a medical concern that requires the attention of the on-call physician, then you may leave a detailed message on the office answering system, and your called will be returned in a timely manner. Be advised that you will be charged a $30.00 fee for this service. Routine requests for medication, scheduling changes or insurance/billing issues will not be addressed after normal business hours.


Financial Policy

All applicable co-pays/co-insurances, fees and deductibles are due and will be collected at the time of service. For your convenience we accept cash, checks and most major credit cards and debit cards.

We are preferred providers for most major health insurance plans. For your convenience, we will be happy to file your insurance claims directly from this office. It is your responsibility to have an active and up to date health insurance identification card at the time of your visit.

You are responsible for any charges not covered or reimbursed by your insurance policy. We do offer a discount program for uninsured patients, and will be happy to discuss any special considerations in the handling of your account.

Any fee listed above that is charged to your account must be satisfied before your next scheduled appointment with a healthcare provider. We reserve the right to refuse non-emergent care to any of our patients who have outstanding balances.

Please contact our billing office during normal business hours if you have any questions or concerns regarding your bill.



Any material discussed in your treatment here will be kept in strict confidence. Except when specified by law, patient records will not be shared with any third parties without the expressed written consent of the patient.


Medical Records

The medical records produced and maintained here in this office are for the exclusive use of the providers of AMG, and all such documents remain the property of this practice. The “Notice Regarding Privacy of Personal Health Information” (copies available for inspection in the office), details how the information in your medical record is handled and shared with other healthcare providers, agencies, insurance companies and or attorneys. As stated in the “Notice Regarding Privacy of Personal Health Information” you are entitled to review this medical record, and you may also request a copy of the record for your personal use. You will be charged a minimum fee of $1.00 per page for the first 10 pages copied, and then an additional $0.30 per page for all remaining pages. This fee must be paid before the medical record will be released. Any request for records to be released or copied must be made in writing, and will require 10 business days to fulfill.


Laboratory & X-Ray Results

The results of any and all diagnostic tests (e.g.: blood tests, x-rays, scans and imaging studies, biopsies) ordered by the healthcare providers of AMG will be reviewed, discussed and made available to you only during a scheduled office visit. In the event that an abnormal result warrants immediate attention, you will be contacted directly by the nursing staff and given specific instructions regarding the treatment plan. The nursing and administrative office staffs are not authorized to release any detailed information regarding the results of diagnostic tests, unless expressly directed by your physician.