Registration Forms

Dr. Reina's New Patient Registration Forms
Dr. Reina's forms ask general and contact information for new patients as well as including insurance
information and next of kin.

New Patient Registration Forms
These forms ask general and contact information for new patients as well as including insurance
information and next of kin.

Sleep Questionnaire and Registration Forms
Describe sleep and anxiety issues, keep a sleep diary, register, assignment of benefits and privacy notice.

Epworth Sleepiness Scale Form
The Epworth Sleepiness Scale can be used to assess daytime sleepiness.

Request for Medical Records
This form requests the release of medical records of the patient's medical providers from Tampa Pulmonary to another.

Request for Medical Records
This form requests the release of medical records of the patient's medical providers from another provider to Tampa Pulmonary.

Baycare EMR Consent
Gives details about your health information in Baycare eHX and the consent process.

Notice of Privacy Practices
You have a right to privacy. This document informs you of your rights regarding health information.