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I agree to complete the New Patient Forms prior to the appointment. I understand that failure to complete the New Patient Forms will result in me being charged the No Show Fee and needing to reschedule my appointment.*

I agree to complete the New Patient Forms prior to the appointment. I understand that failure to complete the New Patient Forms will result in me being charged the No Show Fee and needing to reschedule my appointment.*

I agree to arrive at least 10 min prior to my appointment time, I understand that being late will result in the appointment being rescheduled and the No Show Fee being applied.*

I agree to arrive at least 10 min prior to my appointment time, I understand that being late will result in the appointment being rescheduled and the No Show Fee being applied.*

I agree to Latitude Clinic's Terms, Conditions and Consents.*

I agree to Latitude Clinic's Terms, Conditions and Consents.*

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Disclosure

Vanessa Hamalian

is a Family Practice Registered Nurse, Florida Autonomous Practice License
APRN9272277

Sonya Meritt

is a Family Practice Registered Nurse, Florida Autonomous Practice License
APRN3171322

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

NOTICE: The elevator in our building in Sarasota will be renovated soon. The projected start date is 5-29-2023. The elevator will be inoperable for about 4 weeks. Please give us a call if you need assistance on the stairs or if you cannot use the stairs and we will accommodate you as best we can.

Scheduling Notification!

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If not, please fill up History & Consent Form first before scheduling when first time to visit. Thank you!

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