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Terry Hayes, MD

Terry Hayes, MD

Family Physician

4.8 out of 5 stars (319)

Primary Office

Office 1: Baptist Primary Care

11261 San Jose Boulevard
, Jacksonville, FL 32223

904.292.4127

  • Monday 8:00 AM - 5:00 PM
  • Tuesday 8:00 AM - 5:00 PM
  • Wednesday 8:00 AM - 5:00 PM
  • Thursday 8:00 AM - 5:00 PM
  • Friday 8:00 AM - 5:00 PM

Patient Forms

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 - Uniform Donor Form

    This link opens the uniform donor form provided by the Florida Agency for Health Care Administration. This form allows you to indicate your desire to make an anatomical decision after death.

  • 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 History

    Provides your primary care physician with important information about your medical and family history to better diagnose, treat or prevent conditions.

  • 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.