Premier Health Care Inc.

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 PDF Forms

Patient Demographics Form

Medical Records Release Form

Privacy Notice Form

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
One of our physicians - Dr. Vijaya Cherukuri, Dr. Akila Ananthakrishnan or Dr. Consuella G. Margineanu - is your Primary Care physicians
Co-pays are due at the time of service - we accept all major credit cards

FORMS