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Patient Forms

Medical Records Release From PCAIMA Health History Questionnaire PT Registration & Consent to treat Insurance & Payment Form Verbal Communication Authorization Televisit CCM Nonface visits HIPAA Medical Records Request Form to PCAIMA COVID-19 VACCINE SCREENING & CONSENT FORM MODERNA COVID-19 VACCINE FACT SHEET PFIZER COVID VACCINE FACT SHEET FLU/OTHER VACCINES SCREEING/CONSENT FORM FLU/OTHER VACCINES FACT SHEET

Contact :

Preventive Cardiology &
Internal Medicine Associates, P.L.

3606 Maclay Blvd. Suite 104

Tallahassee, FL 32312

Phone: (850) 210-0593

Office Hours:

Holidays and Weekend – Closed

Direction: