New Patient Forms and Information

Welcome to Anchor Pediatrics and Family Care! For your convenience, you may access the following New Patient forms to assist us with your care. Please print and fill out the appropriate forms, and bring them with you to your first appointment -OR- please select the provided link to complete your new patient paperwork prior to your first appointment.

All Patients

• NOTICE OF FINANCIAL POLICY
• Map of our Main Campus (Jacksonville)
• NOTICE OF PRIVACY PRACTICES

Adults

• Adult New Patient Packet
• Adult New Patient Packet (SPANISH)
• Advance Directive for All Adults (SPANISH)

Allergy Asthma and Sinus

• Allergy New Patient Packet

Pediatric

• Pediatric New Patient Packet

Behavioral and Mental Health

• Authorization for Release
• NOTICE OF FINANCIAL POLICY – BMH
• Review of Systems
• Telemedicine Consent to Treat

Additional Resources

• JCMC Medical Information Release Request To JCMC
• Medical Information Release Request From JCMC
• Notice Of Privacy Practices
• To Enroll or Request a PCM Change
• TRICARE PCM Change Form
• Medicare Shared Savings Program
• Medicare Shared Savings Program (SPANISH)