Patient Registration Forms
Dr. Alexander Lurie in Miami Beach, Florida welcomes you to our practice. Once you have made your initial appointment, you may preregister by downloading, printing, and completing the forms below. Doing so prior to your visit will help speed up the new patient registration process.
Also, be sure to bring to bring all forms with you to your first visit, along with any diagnostic films or other test results that may have been ordered or performed by another physician.
New Patient Registration Forms:
- Patient Registration Form
- Telehealth Informed Consent Form
- Email Consent Form 2021 English
- Authorization to Disclose Health Information English
- Notice of Privacy Acknowledgement - English
- HIPAA Acknowledgement - English
New Patient Spanish Forms:
- Telehealth Informed Consent Form
- Email Consent Form 2021 Spanish
- Authorization to Disclose Health Information Spanish
- Notice of Privacy Acknowledgement - Spanish
- HIPAA Acknowledgement - Spanish
Follow up Patients:
Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.
