Forms can be completed online through the patient portal or you can print them from our website and bring them with you to your appointment.
"Dr. McConnell is a physician that goes beyond what any doctor could ever be expected to do. He takes time to listen and understand, then researching your concerns and gives the best choices for treatment. I am so grateful for Dr. Jeremy McConnell! So wish we had more doctors that really care like him."
HIPPA Disclosure Agreement & Disclosure information
SLEEP MANATEE – Sleep Disorders Questionnaire
No Show/Late Cancellation Policy
Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations. Política Financiera (PDF)
Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully. Aviso de prácticas de privacidad (PDF)