Forms

FORMS:

There are certain paperwork and forms to be completed by each client before seen by the Doctor on your first visit. Please download the forms and complete them prior to your office appointment.

Please bring following with you on your first visit and also for all
subsequent visits:

1) A Photo ID.

2) Insurance Cards.

3) And any Co pays/ Deductibles to be paid at the time of service.

4) Please bring a list of or all your current medications with you.

Please notify the staff if any changes in your health insurance, as you may be responsible for the payments if your insurance does not pay for the services.

HIPAA Privacy Notice. You may print a copy for yourself or just read this notice online.

TO PHYSICIANS OFFICES, PSYCHOLOGISTS AND COUNSELORS:
To refer a client to Dr.Vangla, we appreciate if you could complete this form as much information as possible and fax it to (863) 419-7655. We will contact the client directly or you, with the appointment time and date.

You need adobe Acrobat Program to view above documents.
If you do not have the Adobe Acrobat you can download a FREE copy from the link below.

http://www.adobe.com/products/acrobat/readstep2.html

MID-FLORIDA PSYCHIATRY CENTER PL

Vidyasagar R Vangala, M.D.