new patients welcome 14107 Cortez Blvd, Brooksville, FL 34613
Here at 360 Infusion Center we are always accepting new patients. Regardless of whether you are sick or are simply due for a regular check-up, we are happy to welcome you to our office. We know going to the doctor can be a little overwhelming at times, so we are happy to provide you with our new patient forms ahead of time so that you can fill them out prior to your appointment and save you time during your visit.

Remember to bring a list of any medications you may currently be taking as well as any previous medical records you may want to provide. Our mission is to provide quality care to our patients, and we are happy to help you in any way we can. For more information or to request an appointment, contact us today at (352) 549-9962.

Services

 

Online Forms

Patient Registration and Financial Policy Form – Download & Print | Fill Out Online
Full Patient Medical History Form – Download & Print | Fill Out Online
Patient’s Bill of Rights Form – Download & Print
Covid-19 Patient Screening Questionnaire Form – Download & Print | Fill Out Online
Authorize to use or disclose medical records Form – Download & Print | Fill Out Online
Patient insurance OPT out policy form – Download & Print
HIPAA notice of Privacy practices Form – Download & Print | Fill Out Online
Patient consent Form – Download & Print | Fill Out Online

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