, Jacksonville, FL 32256
- Monday 7:00 AM - 5:00 PM
- Tuesday 7:00 AM - 5:00 PM
- Wednesday 7:00 AM - 5:00 PM
- Thursday 7:00 AM - 5:00 PM
- Friday 7:00 AM - 5:00 PM
Welcome to Baptist Primary Care. To help expedite your first visit, we provide our health forms online so that you can print and complete them at your convenience. If you have any questions, please don’t hesitate to contact our office staff.
Baptist Primary Care Forms
Advance Directives - Designation of Health Care Surrogate Form
This link opens the official designation of health care surrogate form provided by the Florida Agency for Health Care Administration. This form allows you to designate another individual to make treatment decisions on your behalf.
Advance Directives - Living Will Form
This link opens the official living will form provided by the Florida Agency for Health Care Administration. This form allows you to document your instructions to your doctor to provide, withhold or withdraw life-prolonging procedures.
Advance Directives - Overview
This link opens the official Florida Agency for Health Care Administration website. It provides detailed information about advance directives, patient's rights, frequently asked questions and forms.
Advance Directives - Wallet Card
This link opens the Advance Directives wallet card provided by the Florida Agency for Health Care Administration.
BPC Authorization for Use of Answering Machines
Authorizes Baptist Primary Care to leave appointment, referral and test results information on your answering machine.
BPC Health Care Status Authorization
Authorizes Baptist Primary Care to release information concerning the status of your health care, including laboratory and radiology results and to discuss your treatment plan with an individual that you name.
BPC Patient Registration and Authorization
Captures patient demographic information, insurance information and authorizes Baptist Primary Care to prepare and submit your medical bill directly to your insurance company.
Medical Records Request or Release
Initiates your request to have your medical records sent to another medical provider and/or to request your medical records from another provider be sent to your primary care doctor.