Florida Sleep Institute
4075 Mariner Blvd.
Spring Hill, FL 34609

Office: (352) 683-7885
Fax: (352) 683-7877

Information

All necessary forms are available from this page. Click on the link to open the form in a new window, then print it from your computer, closing the window after the form has been printed. You will be returned to this page. Repeat this procedure to display and print all appropriate forms. Your rights and privacy issues are addressed in the Privacy Practices document. If you have any questions, please contact our office.

Note: All forms are in Adobe Acrobat© format. To view them you will need Adobe Acrobat Reader©.

Please print and complete the following form (8 pages), available here for your convenience, and bring it with you for your appointment. If you prefer, you may arrive 30 minutes prior to your appointment and fill the form out in the office.

• Patient Questionnaire
  
  

The following forms are provided for your convenience only. They do not need to be printed out.

• Florida Sleep Institute Patient Consent Form
  
  
• Doctor Kohler Patient Consent for Treatment
  
  
• Patient Medical Information Release Form
  
  
• Patient Notice of Privacy Practices (HIPAA)
  
  

We have a waiting list for new patient appointments, so if for any reason you are unable to keep your scheduled appointment, please contact our office 24 hours in advance. There may be a $20.00 charge for blocked time if you do not advise us of your cancellation.

We look forward to seeing you for your office visit. If there are any questions, please do not hesitate to contact us.

Medicare Patients

We accept Medicare assignment. If you have a secondary insurance with which we participate, we will bill this for you. If we do not participate with your secondary insurance, the co-payment would be due at the time of service. We will, however, submit your secondary insurance as a courtesy to you. Please be advised that you are responsible for any deductible amounts.

HMO Patients

Please obtain the required referral PRIOR to your appointment. If you come for your appointment without this referral, it will be necessary to reschedule your visit for a time when you will have an authorization. Please be advised that all co-payments amounts are also due at the time of service.

Email us at fsi@flsleep.com