Patient Forms

General Forms & Information

• File

  Non Discrimination Notice (Spanish)
• File

  Non Discrimination Notice
• File

  Advanced Directives
• File

  Patient Disclosure of Information
• File

  Disclosure for Out-of-Network Benefits
• File

  Patient Bill of Rights
• File

  Pre-Anesthesia Assessment
• File

  Right to Receive a Good Faith Estimate of Expected Charges
• File

  Notice Regarding Patient Protections Against Surprise Billing

Florida Transparency Bill

• File

  Financial Policy
• File

  Financial Verification Form

Services may be provided by other healthcare providers who may bill separately.

Anesthesia Professional Services

4919 Memorial Highway, Suite 200

Tampa, FL 33632

(866) 631-7890

BayCare Laboratories

210 Jeffords St.

Clearwater, FL 33756

(727) 394-674