Telephone: (386) 774-9890
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We are located at:
1067 Town Center
Orange City, FL 32763

Telephone:
(386) 774-9890

Patient Forms

 

Welcome to Jose A. Lopez-Cintron, MD, LLC. We appreciate the opportunity to serve your medical needs.

Please print and bring these forms with you at your first appointment

Gynecology StaffAll patients are required to bring their insurance card and drivers license to every appointment as well as the applicable co-pay, co-insurance and/or deductible (if applicable).   The office does accept credit cards (Mastercard and Visa), checks and cash.    Payment for medical services is expected on the day the services are rendered.   Upon check-in, we will collect your deductible, copayment, non-covered services, or percent of your responsibility.  Please be prepared to pay before you are seen by the doctor. 

Please download the New Patient paperwork and bring to your appointment.  This will reduce your wait time. 

A detailed medical history will be obtained by the staff and Dr. Lopez.  Please bring with you any previous medical records, a list of all medications (or bring the medication bottles) and any radiology reports that may be needed for your appointment.   Dr. Lopez feels it is in your best interest to have your previous medical records for your first office visit, we may have to ask you to reschedule if they are not available. 

If a follow-up appointment is needed we will be glad to schedule it on your way out or send you a reminder card in the mail. 

If a mammogram, ultrasound or any other radiology appointment is needed, we will be more than happy to assist you with that appointment.  Please make sure to provide us with dates and times that you would be available. 

If any labs are ordered during your appointment, your results will be available within 2 weeks.   Please feel free to follow-up with our office if you have not heard from us.