New Patient Information

We accept all major health insurance plans, including Medicare, AARP, Blue Cross/Blue Shield, Aetna, Cigna, United, Humana, Tricare, Coventry, and many others.

Our biller, Susan, will be happy to answer any questions you may have about insurance coverage. (813) 960-7841.

At your first visit, you will receive a comprehensive review of your medical history, thorough physical exam, and any appropriate lab testing.

Please download and complete the following forms before coming for your first visit.

Medical History, Adult

Medical History, Child 6 to 17 years old

Patient Demographics

Insurance Authorization

HIPAA Acknowledgement

Myrtle Ridge Family Medicine

Northfork Professional Park 1539 Dale Mabry Hwy, #102 Lutz, FL 33548
Phone: (813) 909-7102 Fax: (813) 909-0199
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