Before starting your Patient Health Form, please gather and have available:

  • The names, addresses and phone numbers of your physicians
  • A list of all medications you are taking, their dosage and frequency
  • A list of past surgical procedures and their approximate dates
NOTICE
If you have any problems completing your health form online, please contact the HIMS Department at 863.683.2428, ext. 1338, during normal business hours. If you are not able to complete your health form online, a clinical team member will call you prior to your procedure. If you have not completed the online form or communicated with LSDC, please bring the above medical information with you to your appointment.
Begin your online health form