Patient Forms & Policies

PREPARE FOR YOUR VISIT

Save time at check-in by reviewing and completing these forms before your appointment. Please bring the signed forms with you to your visit.

Authorizes Square Medical Center to provide medical evaluation and care.

Explains how your health information may be used and disclosed, and your rights under HIPAA.

Confirms that you have received and reviewed our Notice of Privacy Practices.

Our office policies, including appointments, cancellations, and patient responsibilities.

Details our policy regarding returned payments and outstanding balances.

Consent to receive care through secure telehealth visits.

Questions about any of these forms? Contact our office: (305) 395-5078 · office@squaremedicalcenter.com

Schedule a Telehealth Visit

Book a virtual appointment online, or contact our team with any questions.