Primary Care Physician in Palm Bay FL | Dr. Oriana Ramirez
Primary Care Physician in Palm Bay FL | Dr. Oriana Ramirez
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Dr. Oriana Ramirez Patient Forms English & Spanish

Dr. Oriana Ramirez, Primary Care Physician in Palm Bay

Primary Care Physician Patient Forms

Preparing for your visit with Dr. Oriana Ramirez, Primary Care Physician in Palm Bay, FL, is easy. Below you’ll find all of the forms needed for new patients, follow-up appointments, wellness care, and telehealth services. Completing your forms ahead of time helps us provide faster, more personalized care

Available Forms

  • New Patient Intake Form
     
  • Telehealth Consent
     
  • HIPAA Acknowledgment
     
  • Consent for Treatment
     
  • Medical Records Release (ROI)
     
  • Wellness & Preventive Care Questionnaire

Instructions / Instrucciones

 Download, fill in the fields, save the form, and attach to contact form Here. Printing and bringing it in is also fine. 

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 Descargue el formulario, complete los campos, guárdelo y adjúntelo al formulario de contacto aquí. También puede imprimirlo y traerlo a su cita. 

New Patient Forms / Formulario de Nuevo Paciente

New Patient Intake Form Fillable (pdf)

Download

Formulario de Nuevo Paciente (pdf)

Download

HIPAA Privacy Practices / Privacidad HIPAA

HIPAA Privacy Practices Acknowledgment Form Dr Ramirez (pdf)

Download

Reconocimiento del Aviso de Privacidad HIPAA Dra. Oriana Ramirez (pdf)

Download

Consent for Treatment / Consentimiento para Tratamiento

Consent for Treatment (pdf)

Download

Consentimiento para Tratamiento (pdf)

Download

Authorization (ROI Form) / Autorización (ROI)

Authorization to Release Medical Records (ROI) (pdf)

Download

Autorización para Divulgación de Expedientes Médicos (ROI) (pdf)

Download

Telehealth Consent Form / Consentimiento de Telesalud

Telehealth Consent Form (pdf)

Download

Consentimiento de Telesalud (pdf)

Download

Wellness Questionnaire / Cuestionario de Bienestar

Download and print the form, complete it by hand, and bring it to your appointment.

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Descargue e imprima el formulario, complételo a mano y tráigalo a su cita.

Wellness & Preventive Care Questionnaire (pdf)

Download

Cuestionario de Bienestar y Cuidado Preventivo (pdf)

Download
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Primary Care Palm Bay FL. | Dr. Oriana Ramirez

5200 S Babcock St. NE suite 303, Palm Bay, FL 32905

720-313-6204

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Dr. Oriana Ramirez 

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