For your convenience we have included some online forms and a map to our habourside Medical Tower location, which indicates our free valet service.
- New Patient History
- Release of Information (Records)
- Patient Disclosures/Communications Authorization (HIPAA privacy rules)
- Referred Patient Previsit Instructions
- Copies of your medical records that are pertinent to your visit. These may be from you're your referring physician, primary care provider, Hospital or ER records. YOU MUST HAVE actual x-rays/CD's for all x-rays, MRI, CT, Angiogtrams or any other testing pertinent to your visit.
- A list of names, addresses, phone and fax numbers for your referring provider(s), primary care physician or any other provider you wish to receive a copy of your visit notes.
- Your Insurance card or policy
- The completed New Patient History Form (attached)
- A list of all current medications and the dosage
- Medical Students: Students training to become physicians through a four-year course of study for a medical degree at the USF college of Medicine.
- Residents: Physicians training for certain surgical specialty.
- Fellows: Physicians who have typically gone beyond residency training and are continuing their studies in a subspecialty area of their filed.
- Advanced Registered Nurse Practitioners (ARNP): registered nurse who is qualified through advanced training to assume some of the duties and responsabilities formerly assumed only by a physician.
Thank you very much for choosing the University of South Florida Physicians Group and we look forward to seeing you.
Division of Vascular and Endovascular Surgery