Forms Download

- New Patient History English

- New Patient History Spanish

- HIPPA:

New Patient Information

Form #1 Notice of Privacy Practices

- Financial Policy

- Vaccine Consent

- Authorization for release of information

Meet Our Providers

       
  CChan-sm  

Colin Chan, MD

Phone: (727) 571-1688
Fax: (727) 561-0674
12450 Roosevelt Blvd., Ste 101
St. Petersburg, FL 33716

       
  EMartinez-sm   Eduardo H. Martinez, MD

Phone: (727) 391-5008
Fax: (727) 398-1481
8250 Bryan Dairy Rd., Ste 305
Largo, FL 33777

       
  MTovar-sm  

Maritza Tovar Day, MD

Phone: (727) 322-4226
Fax: (727)322-4613
603 7th Street South Suite 480
St. Petersburg, FL 33701