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Forms


 

NEW PATIENT FORMS

Please print and complete all the following forms and bring them with you during your initial visit. Alternatively, you can mail them at least 3 days prior to your visit to the following address:

Premier Health Care, Inc.

Attn : Front Office
218 Pasadena Ave S
St. Petersburg, FL 33707-1251

Click on links to download Word or PDF Forms

 

Before you come to our office visit, please check the following:

 Bring your current insurance card(s) – we are a participating provider on most insurance plans.

 List of current medications with dosage strength.

 Past medical history with physicians you have seen.

Dr. Vijaya Cherukuri is your Primary Care Physician.

 Co-pays are due at the time of service – we accept all major credit cards.

Location

PREMIER HEALTH CARE INC
218 Pasadena Ave S
Saint Petersburg, FL 33707
Phone: 727-345-0160
Fax: 727-345-0100

Office Hours

Get in touch

727-345-0160