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.
We accept most commercial insurances. Please call the office in advance to verify if we take your insurance. We also accept Medicaid and Medicare. If you do not have insurance, ask for a case manager to work with you on a self-payment option, using a sliding scale based on your household income and family size.
Raja Talati | MD, MBA, MSC, FAAFP was a past board member and then joined the team as Assistant Chief Medical Officer and Primary Care Physician at Midway specialty Care Center. He is involved with the informatics, IT and development of the telemedicine program. Dr. Talati sees patients at Midway Specialty Care Center in Fort Pierce as well as providing Family Medicine care to patients at Midway Primary Care in Port St. Lucie.
He is a Clinical Professor of Family Medicine for Florida State 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:
Infection Control, Utilization, Ethics, Medical QA 2011 ,Infection Control, Medical executive as Vice Chief of Staff and is now Chief of Credentials.
In the Community he was the local soccer clubs staff physician and also was the Consulting Physician at Sungrove Montessori school when they were trying to earn accreditation.
For his country, he currently holds the position of Chief of Aerospace Medicine for the 927th AMDS at MacDill AFB and was previously the Chief of Credentials. He has about 400 hours of flight time in the C-17 and 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.
Ashley earned her Bachelor of Science degree in Health Sciences with a minor in Global Public Health from The Ohio State University in Columbus, Ohio. She earned her Bachelor of Science in Nursing and Master of Science in Nursing from MGH Institute of Health Professions in Boston, MA. She is board certified as an Adult/Gerontology Primary Care Nurse Practitioner by the American Nurses Credentialing Center. Ashley has experience working in infectious disease. She is passionate about providing care that improves her patients’ quality of life. Ashley is an animal lover and in her free time enjoys spending time with her dog Charlie.
Patients’ Responsibilities All patients are expected to be an active participant in their health care by: