New Patient Information

Thank you for choosing Bariatric & Laparoscopy Center for your health needs.  To schedule your new patient appointment please complete the  new patient forms below.  We look forward to seeing you!

We are in network providers with the following insurance companies: Aetna, Avmed,  BCBS, Beech Street, Careplus (Need PCP Referral), Cigna, First Health, Freedom-Medicare HMO (Need PCP Referral),  Great West, Health Choice, Humana- PPO, HMO, POS, Humana Gold/Medicare (Need PCP Referral), Medicare, Tricare Standard and (Prime- need referral), and United Health Care.

Click on Link, print forms and email back to [email protected] or fax to 321-843-6472

    New Patient Forms 2018


    We accept most major insurance plans at our practice.  Please call the office to speak with one of our knowledgeable staff members about your individual coverage.

    Co-Pay and Deductibles

    To keep billing cost down, we require that all charges be paid at the time service is rendered. You are responsible for all co-pay and deductibles. You may pay with cash, check, or check card.


    In the event that you need to cancel your appointment, kindly provide 24 hours notice. Your consideration in this matter will allow us to accommodate other patients who could benefit from an appointment, no show fee will be charged of $25.

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