This form is to be filled out to release information to send medical records to another provider, to send evaluation reports to someone outside of this office, to receive a copy of your records, etc.
Please fill out this form if you are having an initial appointment with Dr. James Ferro.
Please fill out this form if you are having an initial appointment with Nicolina Demuynck, DNP or Nicole Schultz, ARNP.
All New Patients MUST complete this form in it's entirety.
If you are an existing patient you may be asked to fill out this form to ensure all information on file is still correct.
Please complete the appropriate forms and return via email to firstname.lastname@example.org. You may access them by clicking on the dark blue box. These are all in PDF format. The forms must be printed, completed, and returned. If you do not have a printer please contact our office for further instruction.
Call Us: (321) 751-1925