First Choice Neurology

Patient Information

First Choice Neurology welcomes new patients. We currently have 70 Neurologists as well as diagnostic and rehabilitative services located throughout Florida.

The mission of First Choice Neurology is to improve the quality of neurological services while providing those services in a cost-effective manner to the communities we serve.

 

Patient Forms

Please print the applicable forms below. Complete the forms and bring to your first appointment.

Assignment of Benefits and Financial Responsibility Form (English)
Assignment of Benefits (Spanish)
HIPAA Privacy Acknowledgement
FC HIPAA- English
FC HIPAA- Spanish
Records Release for MRI
Consent for MRI Gadolinium
Recurring Credit Card Authorization Form
Sleep Self Test Tear Off
Headaches Botox Questionnaire
Magnetic Resonance
Personal Item Notice
HMO Authorization Waiver
Non-discrimination and Accessibility Form
Information on Nonopioid Alternatives for the Treatment of Pain


Insurance

We understand that seeing a doctor is only part of your medical experience. Billing and payment for health care services can be confusing and complicated. We try to help patients with insurance questions before their initial visit, so they can make an informed decision regarding their out-of-pocket costs. Please call the physicians office prior to your visit to confirm that your medical visit will be covered by your health insurance provider.

Read about Selecting the Right Health Insurance Plan by Dr. Antonio Mesa.

Notice to Aetna Insurance Patients - Click here to read


Patient Information - First Choice Physicians

Insurance accepted for physicians

Auto Insurance
AvMed
Beechstreet
Care Plus (NON-Capitated PCP)
Cigna
Devoted Healthcare Plan
Doctors Healthcare Plan
Gallagher Bassett
Golden Rule
Humana Gold

Humana PPO/EPO
Humana Premiere
MMM of Florida
Medicare
Multiplan
Neighborhood Health Plan
Occunet
Private HealthCare Systems
Simply Healthcare plan (No Medicaid)
TriCare for Life
United Health Care
Workers Comp

 

Patient Information - First Choice MRI

Insurance accepted for the MRI Center

Auto Insurance
AvMed
Beechstreet
Care Plus (NON-Capitated PCP)
Cigna
Coventry (No Medicaid)
Gallagher Bassett
Humana PPO/EPO
Humana Premiere
MMM of Florida
Medica
Medicare
Multiplan
Neighborhood Health Plan
Occunet
Private HealthCare Systems
Preferred Care Partners
Simply Healthcare plan (No Medicaid)
TriCare for Life
Workers Comp

Patient Information - First Choice Therapy

Insurance accepted for Therapy Centers

Auto Insurance
AvMed
Beechstreet
Cigna
Devoted Healthcare Plan
Doctors Healthcare Plan
Golden Rule
Humana PPO/EPO
Humana Premiere (No Humana Gold Plus)
MMM of Florida
Medicare (No Authorization Required)
Multiplan
Occunet
Private HealthCare Systems
TriCare for Life
United Health Care (AARP Secure)
Workers Comp


Patient Information for Infusion Centers

Insurance accepted for Infusion Centers

Auto Insurance
AvMed
Beechstreet
Care Plus (NON-Capitated PCP)
Cigna
Coventry (No Medicaid)
Gallagher Bassett
Humana PPO/EPO
Humana Premiere
MMM of Florida
Medicare
Multiplan
Neighborhood Health Plan
Occunet
Private HealthCare Systems
TriCare for Life
Workers Comp

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