Registration Forms

For your convenience, the registration forms are in a Portable Document Format (PDF) to retain the original format and easy printing. To view or print these documents, you must use the Adobe Acrobat Reader. Click here to get the forms now.

Patient Registration

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Click Here to Download

Patient Survey

patient-survey

Click Here to Download

Quest Verification

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Click Here to Download

Privacy Notice

Privacy Notice

Click Here to Download

If you have any questions or complaints, please contact:
South Tampa Immediate Care
Diane Hartzner
(813) 253-2113