If you prefer to download, print and complete the new patient forms, please click the link(s) below:
English Downloadable Forms
Spanish Downloadable Forms | Hoja De Registro De Pacientes
HIPAA Privacy Notice (En)
HIPAA Privacy Notice (Sp)
About Your First Visit
In order to help your experience with us be as comfortable as possible, here is some information about your first visit. Depending on your situation, your doctor will ask you a series of questions about your health history, symptoms and other related questions. Then, you will undergo a physical examination that will assist the physician in determining more about your condition. After the physical examination, the doctor will speak with you and give you some recommendations for treatment.
Please bring the following with you to your appointment. For your convenience, you can download our forms and fill them out prior to coming in for your appointment:
Health Insurance Card/Information
Your Photo ID
Your co-payment, if indicated on your insurance card
A friend or family member, if needed, to take notes/help with questions
A list of all medications you are taking
A list of your questions/concerns
Copies of records from doctors related to your visit with us
Cancellation of an Appointment
If it is necessary for you to cancel your scheduled appointment, we require that you call the office at least one (2) working days in advance. Appointments are in high demand, and early cancellation will give another person the possibility to have access to timely care.
How to Cancel Your Appointment
To cancel an appointment, please call 407-384-7388. Please speak directly with a scheduler. Cancellations via email cannot be accepted at this time.
Late Cancellations or No Show
Patients failing to cancel their appointment as indicated above (at least 24 hrs in advance) will be billed an administrative fee: Office visit: $25; Endoscopic procedure: $100
All fees must be paid in full prior to the scheduling of future appointments.
Thank you for your cooperation.
Digestive and Liver Center of Florida,P.A is the sole owner of the information collected on this site. We will not sell, share, or rent this information to others in ways different from what is disclosed in this statement. Digestive and Liver Center of Florida,P.A collects information from our users at several different points on our website.
In order to use this website, a user may be required first complete the registration form. During registration a user is required to give their contact information (such as name and email address). This information is used to contact the user about the services on our site for which they have expressed interest. It is optional for the user to provide demographic information (such as income level and gender), and unique identifiers (such as social security number), but encouraged so we can provide a more personalized experience on our site.
We use IP addresses to analyze trends, administer the site, track user’s movement, and gather broad demographic information for aggregate use. IP addresses are not linked to personally identifiable information.
We will share aggregated demographic information with our partners and advertisers. This is not linked to any personal information that can identify any individual person.
We use an outside shipping company to ship orders, and a credit card processing company to bill users for goods and services. These companies do not retain, share, store or use personally identifiable information for any secondary purposes.
We partner with another party to provide specific services. When the user signs up for these services, we will share names, or other contact information that is necessary for the third party to provide these services.
These parties are not allowed to use personally identifiable information except for the purpose of providing these services.
This web site contains links to other sites. Please be aware that we [Digestive and liver center of florida,P.A. are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of each and every web site that collects personally identifiable information. This privacy statement applies solely to information collected by this Web site.
If a user wishes to subscribe to our newsletter, we ask for contact information such as name and email address.
This website takes every precaution to protect our users’ information. When users submit sensitive information via the website, your information is protected both online and off-line.
When our registration/order form asks users to enter sensitive information (such as credit card number and/or social security number), that information is encrypted and is protected with the best encryption software in the industry - SSL. While on a secure page, such as our order form, the lock icon on the bottom of Web browsers such as Netscape Navigator and Microsoft Internet Explorer becomes locked, as opposed to un-locked, or open, when you are just ‘surfing’.
While we use SSL encryption to protect sensitive information online, we also do everything in our power to protect user-information off-line. All of our users’ information, not just the sensitive information mentioned above, is restricted in our offices. Only employees who need the information to perform a specific job (for example, our billing clerk or a customer service representative) are granted access to personally identifiable information. Our employees must use password-protected screen-savers when they leave their desk. When they return, they must re-enter their password to re-gain access to your information. Furthermore, ALL employees are kept up-to-date on our security and privacy practices. Every quarter, as well as any time new policies are added, our employees are notified and/or reminded about the importance we place on privacy, and what they can do to ensure our customers’ information is protected. Finally, the servers that we store personally identifiable information on are kept in a secure environment, behind a locked cage.
If you have any questions about the security at our website, you can send an email to: [email protected]
Site and Service Updates
We also send the user site and service announcement updates. Members are not able to un-subscribe from service announcements, which contain important information about the service. We communicate with the user to provide requested services and in regards to issues relating to their account via email or phone.
Correction/Updating Personal Information:
If a user’s personally identifiable information changes (such as your zip code), or if a user no longer desires our service, we will endeavor to provide a way to correct, update or remove that user’s personal data provided to us. This can usually be done at the member information page or by emailing our Customer Support.
Our users are given the opportunity to ‘opt-out’ of having their information used for purposes not directly related to our site at the point where we ask for the information. For example, our order form has an ‘opt-out’ mechanism so users who buy a product from us, but don’t want any marketing material, can keep their email address off of our lists.
Users who no longer wish to receive our newsletter or promotional materials from our partners may opt-out of receiving these communications by replying to unsubscribe in the subject line in the email or email us at
Users of our site are always notified when their information is being collected by any outside parties. We do this so our users can make an informed choice as to whether they should proceed with services that require an outside party, or not.
Notification of Changes