Winter Park – Midway Specialty Care Center
Emmanuelle Allseits, MD
(407) 745-1171
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!
Directions:
- Download the forms to your computer by clicking on the “download the forms”.
- Print the form and fill it out with a pen.
- Bring the completed forms with you to your appointment.
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.
Emmanuelle Allseits MD
Emmanuelle Allseits, MD attended FIU Herbert Wertheim College of Medicine in Miami, Florida and then moved to Chicago, Illinois where she completed an Internship & Residency in Family Medicine at the University of Illinois. Dr. Allseits followed her passion and completed a Fellowship in HIV with the University of Southern California at Los Angeles County Department of Health Services. She is an HIV specialist who is AAHIVS Certified.
Patients’ Responsibilities
All patients are expected to be an active participant in their health care by:
1. Assuming responsibility for certain aspects of their care.
2. Providing the health care team with a complete medical history including access to prior medical record.
3. Preparing for their appointment by bringing a list of their medications and any questions or issues that they have with regard to their diagnosis and treatment.
4. Following the Care Plan that the health care team has developed for them and communicating to the health care team any deviation from that plan.
5. Contacting the clinic for advice before going to the Emergency Room for non-urgent conditions.
6. Working with the care team to learn how to self-manage their care.
1685 Lee Road, Suite 110
Call to schedule an appointment in our Winter Park Office at 407-745-1171