• Office Hours

    Office HoursX

    MONDAY08:30 AM - 4:30 PM

    TUESDAY08:30 AM - 4:30 PM

    WEDNESDAY08:30 AM - 4:30 PM

    THURSDAY08:30 AM - 4:30 PM

    FRIDAY08:30 AM - 4:30 PM

    SATURDAYCLOSED

    SUNDAYCLOSED

  • (805) 371-0770

Forms

FORMS

To save time at your new patient initial appointment, print and fill in the following four forms and bring them with you to the check-in desk:

To comply with HIPAA mandates, returning patients, on an annual basis, will have to fill out both an updated Patient Information Form and Financial Policy Form. Bring both completed forms to your annual visit to save time at check-in.

All patients must also bring with them their insurance card (or a photocopy). Copies of all recent pertinent records are appreciated.

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For Dr. Taylor’s patients requesting records to be sent; Iron Mountain is storing, cataloging and sending her medical records. If you want records sent to a facility a doctor or yourself, Please download the HIPPA authorization form from Iron Mountain below:

You can mail, fax or email the request to:

Iron Mountain ROI
8100-2A Westside Industrial Dr.
Jacksonville, Florida 32219

Fax 904-695-4247
Phone 904-695-1604

JAX.ROI@ironmountain.com

Please be sure to note that you are requesting records from Nancy A. Taylor, M.D. and fill out the form completely.

Iron Mountain will take care of sending the records at no cost to you.

 

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1220 La Venta Drive, Suite 205 Westlake Village, CA 91361
(805) 371-0770