Patient Forms
NEW PATIENT FORMS
The New Patient Pack contains a new patient registration form, health history form, privacy policy and others. Please select the Pack that is appropriate for the insurance you are using – if unsure please use the General Patient Pack.
Print and complete all pages prior to your arrival and bring them with you to your visit. This will help speed up the new patient registration process and get you in to see the doctor faster.
FORMS CURRENTLY BEING UPDATED
MEDICAL RECORDS REQUEST
f you are a patient and would like Dr. Rizk to request Records on your behalf, please download and complete the Records Request form and fax to the facility that you would like to send the records to Dr. Rizk. Or you may simply ask for a form at your next visit.
DENTAL PROCEDURES
If you have a joint replacement, you will need to let the dentist or hygienist know before you have any dental work done. We ask that you take antibiotics as a preventative action prior to any treatment.
Here is a form you can print and bring with you to your dental appointment so they will know what to prescribe.
FaQs
Your questions, answered.
If you are a patient of the Heekin Clinic, you will need to complete a records request form found here so that we may obtain your records. If you are a patient of any other clinic you may request a release form by calling their office.
We have release forms in our office; otherwise you can fax a request that includes your personal information as well as information on where records are to be sent.
Yes, we are on call 24 hours a day, 7 days a week. Call our main number, 904-731-3131 for assistance. Please note that prescriptions are refilled during office hours only.
We generally do not require a physician referral to our office for the purpose of scheduling an appointment with one of our physicians, unless this is a requirement by your insurance carrier.
While X-rays are generally not required, all MRIs or other image studies on CD or film that are pertinent to the part of body being examined need to be brought in with the patient.
With a 48-hour notice, you may call your doctor’s assistant or you may call your pharmacy and they will request a refill from your doctor. Please note that Schedule II drugs cannot be refilled by phone and require a paper prescription.
Yes and Yes. Please park on the 6th floor of the DePaul garage and call the office in advance if you require assistance getting into the building.