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Palms Medical Group
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Call 1-888-730-2374
for information about services, to set up an appointment, after-hours services, or to speak with a Financial Services Specialist.

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Patient Forms

We accept medicaid, medicare & uninsured patients.

Financial Assistance Available!

For your convenience, we've posted some of our more commonly used forms. You may download these forms, fill them out and deliver them to Palms Medical Group at your doctor requests.We serve patients from Gainsville, Orange Park, Stark & High Springs, FL with top quality medical care. We offer same day appointments for your convenience. Contact us today for more information.

Sliding Fee Scale Forms

Acrobat Document Sliding Fee Application (Eng)
Acrobat Document Aplicacion Para Cuotas Reducidas (Esp)

Chiropractic Forms

Acrobat Document Chiropractic New Patient Questionnaire

New Patient Forms

Acrobat Document New Patient Forms (Eng)
Acrobat Document Registro Del Paciente (Esp)

Medical Records Release Forms

Acrobat Document Medical Records Release

Advance Directive Forms

Acrobat Document Advance Directive
Acrobat Document Advance Directive (Esp)

Patient Centered Medical Home

Acrobat Document Patient Centered Medical Home Signup Form

NOTE: You must have Acrobat Document Acrobat Reader installed to view the file above.
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This institution is an equal opportunity provider and employer.
Palms Medical Group is a FTCA Deemed Facility.
This health center is a Health Center Program grantee under 42 U.S.C. 254b,
and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).

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