For all appointments and inquiries, please call 855-3FASTMD (855-332-7863)
We have partnered with MediCopy to fulfill Release of Information requests and Disability/FMLA forms. MedaCopy is fully HIPPA compliant and adheres to all state and federal regulations concerning the release of medical information
Patients: To request your medical records, please visit medicopy.net/roi Please provide an email address on the authorization to expedite the process and delivery method. Records sent via email or to another provider are complimentary. Requests are completed within two (2) business days after receipt by MediCopy.
Third-Party Requesters: To request medical records please visit https://medicopy.net/thirdpartyrequesters
Patients: To submit FMLA/Disability forms please visit medicopy.net/forms
Forms are $30 for the first form and $15 for each additional form turned in at the same time. After payment is received, Disability/FMLA forms are completed within three business days.
If you have any questions, please contact MediCopy:
online chat: MediCopy.net | phone: 866-587-6274 | email: firstname.lastname@example.org
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call727-807-2476.
New Patient Forms:
There are 2 versions of the "assignment of benefits" form. The Tricare, Cigna, Wellcare, and Department of Labor form is for patients using that coverage. The FASTMD is for all other patients.
Anesthesia Pre-Operative Assessment Form
Insurance List for FastMD Centers:
- AETNA SELECT
- BLUE CROSS BLUE SHEILD
- CHAMP VA
- CIGNA BAY CARE
- CIGNA GREAT WEST
- GHI/ EMBLEM HEATH
- GOLDEN RULE (UHC)
- HUMANA PPO/POS
- HUMANA GOLD
- MEDICARE/MEDICARE RAILROAD
- MERITAIN (AETNA NETWORK)
- TRICARE STANDARD
- TRICARE PRIME
- UNITED HEALTH CARE (CHOICE PLUS PPO)
- UHC (MEDICARE ADV/COMPLETE PPO)
- ULTIMATE MCR
- WELLCARE MCR
Insurance we are out-of-network with but will accept:
- UHC Medicare
- UHC Wellmed PPO
We accept Auto Accident, Slip and Falls and Work Comp.
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Saturday and Sunday: Closed
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