ONLINE PATIENT INFORMATION

Our health Center professionals are always close to you and your family.
With them you can establish a personal relationship of trust and advise you on all matters of health.

Here you can find all kind of related information about your visit, payment methods, insurance, patient form and office policy.

Your Visit
Thank you for choosing Dr. Silva’s Ultra Wellness Center for your Primary Care

At Dr. Silva’s Ultra Wellness Center, our patients are always our top priority. We provide convenient, fast and affordable primary care, “The care you need, when you need it the most.”

If you are a new patient, please fill out the registration forms listed below in advance of your appointment to assist the staff in making sure that we have all the information necessary to provide you with quality care and treatment. It is helpful if you bring along copies of previous tests, lab results and the names of any medications or natural supplements you are currently taking. Please bring the completed forms with you along with your ID to the appointment.

Getting Ready for Your Visit

In order for us to provide you with fast, quality care, please bring the following items to your visit:

  • Photo ID (required for credit card, check or insurance verification only).
  • Insurance information (if you have insurance).
  • Copay, deductible or self-pay amounts (due at the time of treatment).
  • List of any current medications.
  • List of any past medical conditions and allergies.
Payment & Insurance
Financial Disclosure

Please contact our office at (954) 943-9670 for any questions related to insurance or payments.

Patient Forms
Patient Registration Forms

For your convenience, please print and fill out all applicable forms and present them to the front desk when you arrive for your first office visit.

To download the forms and information you need, simply click the links below. You can complete these patient forms in advance, or complete the copy provided by one of our Patient Service Representatives at check-in.

Patient Medical History Form

Patient Information Form

Health Information Release Authorization

If you need to give Doctors Care authorization regarding treatment of a minor or to disclose your health information to another provider, we’ve provided the necessary form here:

Authorization for Release of Health Information

Policy and Disclosure
Patient Rights and Responsibilities

We respect our patients’ dignity and pride. This document will explain your patient rights and responsibilities. It is part of your patient registration and is an important part of your health care plan.

Patient Rights & Responsibilities

Privacy Notices

This privacy notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Privacy Notice

Office Policy

Frequently Asked Questions

Frequently Asked Questions about Medical Spa and Medical Spa Treatments.
Keep checking back for more info as it becomes available!

1. General Med SPA Questions

IS THE SKIN REJUVENATION LASER TREATMENT SAFE?

Yes. Skin Rejuvenation has been used on thousands of patients across the globe with beautiful results.

HOW LONG WILL A TREATMENT TAKE?

Your exact treatment regimen will depend on the condition of your skin and your aesthetic goals. One laser treatment may take a few minutes and another may take longer. You may have treatments that involve more than one of the Skin Rejuvenation technologies. Before you get started, ask your provider to estimate how long the session will take.

HOW LONG MY RESULTS LAST?

Skin Rejuvenation is the ideal procedure to eliminate the discoloration, textural irregularities and other signs of aging that make your skin look older. After the procedure you will continue to age and to be affected by the sun and elements. You may choose to return to your provider periodically for touch-up treatments to maintain the healthy glow that Skin Rejuvenationcan bring.

CONTACT US

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