We always welcome new patients and try to offer convenient appointment times.

Step 1:

If you have the proper access code you can access the forms at the link below. Please click the link below to access the forms. You must have the proper ACCESS CODE.

• Access New Patient Forms

To make, reschedule or cancel an appointment, please call our office at 954-792-7303 during normal office hours, or you may leave a message. You may also use our online appointment request form.

Please bring your insurance card. We will need a copy of it for our records. If your insurance plan requires that you have a referral from your primary care doctor, please make sure you obtain one before your appointment.

Print and bring in your completed New Patient Information Forms. This step will save you time on your initial visit!

Complete the form below to access the new patient forms. In order to successfully download our forms you must be a patient. We will call you back to confirm your information and provide you an code to access the patient intake forms.

Tell us about yourself: * Required Information

Mr. Mrs. Ms. Dr. Prof. Title / Salutation

First Name*

Last Name*

Daytime Phone Number*

Cell Phone Number*

Email Address*

Have you been seen by Landman & Associates, Inc. before?

Yes

No

Please list your insurance carrier:

Please list your insurance policy number:

Referral source:

*Please list the nature of your problem, question or comment: