U First Medical Spa, Botox, Skin rejuvenation, fillers, cosmetic procedures Fort Myers, FL

U First Health - New Patient Registration Forms

New Patient Registration Forms - PDF format
You can either fill out these PDFs (get Adobe Acrobat) and save to your computer, then attach the forms and send them in an email addressed to info@ufirsthealth.com; or you can print, fill out and fax them back to us at 239-236-1595.

Authorization for Release of Medical Records - PDF format
You can either fill out these PDFs (get Adobe Acrobat) and save to your computer, then attach the forms and send them in an email addressed to info@ufirsthealth.com; or you can print, fill out and fax them back to us at 239-236-1595.

Consent to Treat Minor Children Form - PDF format
You can either fill out these PDFs (get Adobe Acrobat) and save to your computer, then attach the forms and send them in an email addressed to info@ufirsthealth.com; or you can print, fill out and fax them back to us at 239-236-1595.

Notice of Privacy Practice - PDF format
If you have any questions about any of this material, please contact us by email at info@ufirsthealth.com; or call us at 239-243-8222.

PLEASE ARRIVE 15 MINUTES PRIOR TO YOUR SCHEDULED APPOINTMENT TIME.  PLEASE DO NOT FORGET TO BRING YOUR PHOTO ID AND INSURANCE CARD(S). REMEMBER TO COMPLETE THE FORMS AND SUBMIT 24 TO 48 HOURS PRIOR TO THE APPOINTMENT.   ********PLEASE NOTE THIS WILL SIGNIFICANTLY DECREASE YOUR APPOINTMENT WAITING TIME!********  

See our Cancellation / No Show Policy

Please remember to call your referring physician and have them fax records to our office 24 to 48 hours prior to your appointment. Our fax number is 1-239-236-1595.

 

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