Freestanding Emergency Centers:
Urgent Care Locations:
Health & Wellness:
The information requested below is essential for providing you with the best estimate for your expected hospital services. If insurance information is provided, we will try to determine co-pay and/or deductible amounts for the most accurate estimated patient responsibility. If insurance information is not listed, estimate will be given based on full patient responsibility.
Submit information by clicking on the "Submit Information" button located at the bottom of this page. Thank you for considering Baptist Health for your healthcare needs. (*Indicates required information)
The Agency for Health Care Administration places an emphasis on health care transparency for Florida's consumers. We have provided a a link to the Florida Health Price Finder website to help you make more informed health care decisions.
Requestor's First Name:*
Requestor's Last Name:*
City, State Zip*
Preferred Time to Contact:
Patient is same as requestor
Date of Birth:*
Type of Service:*
Anticipated length of stay: Days
Estimated OR time for surgery: Hours
CPT Code: This code can be obtained from your physician.
Does this surgery require an implant? Yes
Is observation status anticipated? Yes
Is there insurance coverage for this service?*:
Relationship To Patient:*
Insurance Phone Number: