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New Patient Forms
Let’s get the process started. Please complete the appropriate forms below so that we can learn how to best assist you.
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print NEW PATIENT form
Let’s get the process started. Please complete the appropriate forms below so that we can learn how to best assist you.
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Premier Medical. (PMA) is committed to complying with all applicable federal and state statutory, regulatory, and contractual requirements as required by the Medicare & Medicaid Programs. PMA’s staff, contracted providers, sub-contractors and any other business partners is required to be compliant with annual compliance training and report compliance, or fraud, waste, and abuse issues.
Should you have any concerns please contact us to report compliance or fraud waste or abuse (FWA) issues:
• Email compliance & FWA concerns to: compliance@pmacare.com
• Confidential Reporting Hotline: 352-623-2857
Premier Medical Associates is committed to protecting your confidential information and follow HIPAA privacy and security standards. We may use and disclose your Protected Health Information to provide, coordinate, or manage your health care and any related services.
PMA will not share your information with any third party outside of our organization, other than as necessary to fulfill your request or as needed to manage your health care.
It is the policy of Premier Medical Associates to respond in a timely and positive manner to all complaints submitted by any persons or parties including patients, workforce members, or any other person or party. If you have any concerns about your privacy, please contact PMA’s HIPAA Privacy Officer Coralia Jennings at (352)-623-2857
Premier Medical Associates (PMA) complies with applicable state, and federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, gender identity or sex. PMA does not exclude people or treat them differently because of race, color, national origin, age, disability, gender identity or sex.
If you have questions about our non-discrimination policy, contact Compliance at compliance@pmacare.com