patient forms for download

  • We encourage patients to read the "HIPAA & PRIVACY" section above prior to their first visit in order to fully understand their privacy and associated HIPAA rights.  Alternately, a hard copy of the above can be requested prior to first visit.  All applicable forms below must be filled out and signed prior to first appointment with Oldsmar Rheumatology
  • We strongly encourage the "Medical Release" form be submitted to our office at least one week prior to your appointment if necessaryi in order for for Dr Thomas  to better serve you.  Necessary records may include: notes/labs/radiology reports from prior rheumaologist , notes/labs/radiology from primary care physician or referring specialist who recommends rheumatologist vist
  • If appointment requires an authorization from your PCP, we ask that you assist us in obtaining this from your PCP.  We assure you that we will make every effort to obtain this authorization independently as well
  • download, fill out, and submit all forms in person at our office during business hours, OR
  • download, fill out and fax all forms back to us at 813-475-6156 

Medical Release form (pdf)


Acknowledgement of HIPAA and Privacy (docx)


ORfinancial (docx)


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