Patient Forms

General Forms

• File

  Non Discrimination Notice (Spanish)
• File

  NON DISCRIMINATION NOTICE
• File

  Advanced Directives
• File

  Right to Receive a Good Faith Estimate of Expected Charges
• File

  Notice Regarding Patient Protections Against Surprise Billing

Florida Transparency Bill

• File

  Financial Policy
• File

  Financial Verification Form

Services may be provided by other healthcare providers who may bill separately.

AmeriPath – SW Florida

1620 Medical Lane, Suite 100

Fort Myers, FL 33907

(239) 275-1164

Cape Coral Anesthesia Services, LLC

2721 Del Prado Blvd S. Suite 100

Cape Coral FL 33904

(239) 242-8010

Evolent

2300 Lakeview Pkwy, Suite 500

Alpharetta, GA 30009

(866) 295-1260