International Patients Form
Complete all information requested below. Without this information, it will not be possible to arrange the appointment(s) you are requesting.
Once you’ve submitted the appointment form, fax copies of your insurance card (front and back), your passport and all pertinent medical reports and records to 305-243-9101. These documents may also be scanned and submitted via email to firstname.lastname@example.org.
If you are experiencing symptoms that are urgent in nature please contact your primary care physician or your nearest urgent care facility.