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Forms

Tarik Shaaban, MD Contents About Practice Forms

 

Please feel free to download the forms below, fill them out and bring them with you to your next visit.

 Patient Intake Form

 Patient Portal Consent Form

 COVID-19 Intake Form

 Telemedicine Consent Form

 Notice of Privacy Practices Form

 Authorization For Release of Health Information

 Consent for Treatment of a Minor Child

What we offer

Services

 

Location

Access Point Healthcare
2306 Martin Luther King Jr. Boulevard
Panama City, FL 32405
Phone: 850-360-1380
Fax: 850-250-0022

Office Hours

Get in touch

850-360-1380