New Patient Forms
All new patients should complete the forms and keep the reference document for your files.
Save time before your first visit, by filling out paperwork at home.
When you have completed them, please sign, and bring them to your appointment at Midway Specialty Care.
Please call us if you have any questions about these forms. We look forward to serving you!
If you have trouble with the forms, you may also arrive at our office 15 minutes prior to your appointment and we can provide copies for you to fill out.
Our dedicated team of physicians, physicians assistants, nurse practitioners, nurses, medical assistants, and pharmacists provide comprehensive care with dignity to those living with an infectious disease.
Our goal is to keep you healthier through treatment, so you can live a better life with drug therapy to keep your virus or infection at a manageable level. Our goal as well is to the reduce transmission of infectious diseases through healthcare and medicine management on the Treasure Coast. We are proud to announce we are bringing specialty care closer to home for our patients living in Broward, Hillsborough, Indian River, Martin, Okeechobee, Orange, Pinellas, Palm Beach, Dade, and St. Lucie counties.
Your Midway Specialty Care Center healthcare providers have an overall plan for you, which includes your specialized care medical appointments, primary care appointments, a treatment plan with your pharmacy, lab tests, Medication Management Therapy, and many other services.
When you participate in all of these parts, you are engaged in your care.
Our reliable staff at Midway Specialty Care Center is trained in the guiding philosophy of excellence in patient care and treatment and we all share the same concerns for the clients.
Our staff also includes:
During your appointment please ask us about our Medication Therapy Management services. We can help you manage all your medication and nutrition.
HIV is a treatable condition. If you are diagnosed early, get on antiretroviral therapy (ART), and adhere to your medication regimen, you can stay healthy, live a normal life span, and reduce the chances of transmitting HIV to others. Part of staying healthy is seeing your HIV care provider regularly so that he or she can track your progress and make sure your HIV treatment is working for you… Read more
Raja Talati, MD, was a past board member and then joined the team as Assistant Chief Medical Officer. He is involved with the development of the telemedicine program so that patients with limited access to specialty care would be better served. He sees patients at Midway Specialty Care Center in Fort Pierce as well as the providing Family Medicine care to patients at Midway Primary Care in Okeechobee.
He is currently an assistant program director at the St.Lucie Medical Center Family Residency Program and Assistant Professor of Family Medicine at Nova Southeastern University. Prior to this, he was in practice at the Heart and Family Health Institute also in PSL.
He served as the Medical Director at the St.Lucie County Juvenile Detention Center from 2011 to 2017. He has served on numerous committees at St.Lucie Medical Center which include the following:
In the Community he was the local soccer clubs staff physician and also was the Consulting Physician at Sungrove Montessori school.
Infection Control, Utilization, Ethics, Medical QA 2011 ,Infection Control, Medical executive as Vice Chief of Staff and is now Chief of Credentials.
For his country he currently holds the position of Chief of Aerospace Medicine for the 927th AMDS at MacDill AFB. He has about 400 hours of flight time in the C-17 an KC-135.
Since completing medical school, he earned his Masters In Health Information Systems and is a candidate for his MBA with a specialization in Healthcare Analytics.
When not working; he enjoys outdoor activities and traveling with his two sons and wife.
Ms. Bagwell graduated from the University of Tampa with a Master of Science in Nursing and is a board certified adult nurse practitioner. She holds a certification as an HIV specialist from the American Academy of HIV Medicine. Ms. Bagwell joined Midway Specialty Care Center in 2013 at the advent of the direct acting antiviral era for the treatment of hepatitis C. Ms. Bagwell provides treatment for HIV, hepatitis C, pre-exposure HIV prophylaxis, post-exposure HIV prophylaxis, sexually transmitted infections, and primary care. Ms. Bagwell enjoys spending her free with time with her husband and her two daughters.
Lauren Leeflang is a Board Certified Physician Assistant.
Lauren was only two semesters away from graduating with a Bachelor of the Arts in Anthropology from the University of Florida when she enrolled in a Medical Anthropology course. From that moment on, she was fascinated by the societal and cultural influences on healthcare and medicine, leading her to immediately enroll in Florida Atlantic University’s Pre-Health Professions Post-Baccalaureate program upon the completion of her degree. It was there that she learned more about the Physician Assistant profession and the nationwide shortage of primary care providers.
She graduated with honors from the Nova Southeastern University Physician Assistant Program in Orlando, Florida, where she earned her Masters of Medical Sciences. As a PA, Lauren is passionate about primary care, and appreciates the diverse clinical challenges of HIV and other infectious diseases.
A self-described “food nerd,” Lauren spends much of her free time in the kitchen trying new recipes, or brewing beer with her husband. She also loves gardening, the beach, and her adorable dog, Kona.