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Call Us Today!
(904) 249-3820
Call Us Today!
(904) 249-3820

New Patient Forms

New Patient Forms Include:

  1. Registration
  2. Consent
  3. Release
  4. Social History
  5. Privacy
  6. Privacy
  7. Privacy
  8. Privacy
  9. Privacy

Optional Forms/Health Questionnaires Include:

  1. Restless Legs Syndrome
  2. Adult ADHD (Attention Deficit Hyperactive Disorder)
  3. Migraine Questionnaire
  4. Low Testosterone Questionnaire (Men Only)
  5. Mood Questionnaire
  6. Nine Symptom Checklist
  7. Sleepiness Scale
  8. Fatigue Severity Scale
  9. Bladder Evaluation Diary
  10. Anxiety Questionnaire
  11. Urinary Symptoms Questionnaire (Men Only)
  12. Depression Questionnaire
  13. Mood Disorder Questionnaire
  14. Pain Questionnaire
  15. Depression Questionnaire

Call Us Today At ♦ (904) 249-3820

Amer Shahla, MD
 Sean Shahla, MD


JACKSONVILLE BEACH Office
1141 Beach Blvd.
Jacksonville Beach, FL 32250
Phone: (904)-249-3820
Fax: (904)-249-3390
Mon,Tue,Thurs: 9 AM-5 PM
(lunch: 12 PM-1 PM)
Friday: 9 AM-3 PM
JACKSONVILLE  Office
3599 University Blvd South, Suite 404
Jacksonville, FL 32216
Phone: (904)-396-0077
(Open on Wednesday only)
9 AM-5 PM

Payment Options