Call: (239) 325-1135

What you need

what you need

New Patient Forms - must be updated yearly
For New Patients or Updates: Please download this .pdf file. Fill it out to save time when coming in for a visit. (Patient Information Form, Medical Information Form and Review of Symptoms, Financial Policy and HIPAA Notice of Privacy.)

Download

What to Bring

Patient Registration forms

Click above to download them now. You will need to fill them out and bring them with you to your appointment.

 

Insurance Card(s) and a Photo ID

If the appointment is for a minor, you will need to provide the legal guardian’s insurance card(s) and photo ID.

 

Medical Records

Please bring relevant medical records from other physicians; results and copies of X-rays; and other imaging studies and lab tests and bring these items with you to your appointment.

 

Written lists of:

Medications,herbs, vitamin supplements and over-the-counter medications you are taking.

 

Your Concerns

About your condition (pains, loss of mobility or function).

 

A Family Member or Friend

Consider asking a friend or family member to accompany you if you need any assistance in walking, using the restroom or filling out paperwork.

 

Translator

If you need a translator, ask another adult to come with you; don’t rely on a child to translate.

 

Questions

Take the time to make a list of anything you may want to ask your physician regarding your condition.

 

Comfortable Clothes

Your condition may involve X-rays. Wear loose clothing that’s easy to take off and put on.

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Dr. Michael T. Havig

Book an Appointment

Call us

(239) 325-1135