Forms

I have an appointment, which forms do I complete?

I am a New Patient.

I am a New Patient but am being seen for an injury related to an auto accident. (coming soon)

I am a Returning Patient.

I am a Returning Patient but am being seen for a new injury.

I am a Returning Patient but am being seen for an injury related to an auto accident. (coming soon)

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Application for Employment

If you are interested in advancing your career in a challenging, fast paced environment, fill out our Application for Employment and fax the completed form to (561) 727-1203.

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Auto Accident

If you are a new patient being seen for an injury related to an Auto Accident, fill out the Auto Accident form and fax it to us at (561) 727-1230 or bring it with you to your first visit.

View Form (coming soon)

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History Form – Follow Up

If you are currently being treated at PBOI, fill out the Follow Up form and bring it with you to your next appointment to expedite your check in process.

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Medical Records Release Form

If you are requesting medical records, it is required by law the Medical Records Release Form be filled out and returned to our Medical Records department prior to the release of your records. Please fax the completed form to (561) 727-1401.

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History Form – New Patient

If you are a new patient, are being seen for a new problem or have not been seen in our office in the past 3 years, fill out the New Patient form and bring it with you to your next appointment to expedite your check in process.

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History Form – New Patient Pediatric

If you are a new pediatric patient (0-18 years of age) being seen by Dr. Bret Baynham, fill out the New Patient Pediatric form and bring it with you to your next appointment to expedite your check in process.

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