Patient Forms

General Forms

• File

  Advanced Directives
• File

  Non Discrimination Notice
• File

  Non Discrimination Notice (Spanish)
• File

  Patient Bill of Rights & Responsibilities
• File

  Patient Disclosure of Information
• File

  Disclosure for Out-of-Network Benefits
• File

  Pre-Anesthesia Assessment
• File

  Notice Regarding Patient Protections Against Surprise Billing
• File

  Right to Receive a Good Faith Estimate of Expected Charges

Florida Transparency Bill

• File

  Financial Policy
• File

  Financial Verification Form

Services may be provided by other healthcare providers who may bill separately.

ORMC/Orlando Health
1414 Kuhl Ave.
Orlando, FL 32806-2008
(407) 841-5214

PSAP (Through Orlando Gastroenterology)
840 W. Jersey
Orlando, FL 32806
(407) 445-9224 (Orlando Gastroenterology)
(407) 648-4399 (PSAP Lab)

APS
4919 Memorial Highway, Suite 200 
Tampa, FL 33634 
(866) 631-7890

Anesthesia Associates of Greater Orlando (Bolder Healthcare)
(877) 822-6205