AICC
Office Location:
320 S.R. 60 East
Suite 101
Lake Wales, FL 33853
Tel: 863.679.7985
Fax: 863.679.1865

Patient Forms

First time patients please download and complete:
• PHI Release
• Patient Information Sheet
• Financial Policy
Bring all three forms completed and signed to your first appointment.
Make sure you read the "Notice of Privacy Practices"

  • Aviso Sobre la Practica de Privacidad

  • Financial Policy

  • Notice of Privacy Practices

  • PHI Release

  • Patient Information Sheet

  • Patient Information Update

  • Patient Satisfaction Survey

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