Patient Forms

Thank you for choosing Lal Bhagchandani MD P A. In an effort to expedite your checkin process as a new patient, please complete the New Patient Forms before your appointment and either fax to us or bring them with you to your appointment.

Items to bring to your appointment:

• New Patient Forms
• Insurance Card(s) and Picture ID
• Referral if your insurance requires one
• Any and all recent chest X-rays, CT Scans, PET Scans and prior sleep study reports
• Discs and Films are not required, but may bring along if you have them

Please complete the following forms and present them to our staff when you arrive or you may fax them to our office at (954) 917 4940.

• Patient Registration Form
• Records Release Authorization
• Notice of Privacy Practice
• Family/Social History Form
• Past Medical History Form
• Medication List
• Sleep Apnea Questionnaire (For Sleep Patients Only)
• Epworth Sleepiness Form (For Sleep Patients Only)

You will need the Adobe Reader to view and print the above documents.