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New Patient Registration Forms

Thank you for choosing Comprehensive Care Center.  To expedite the patient registration process, and allow us to provide quality medical care, please print and complete this new patient packet in its entirety.  Please fax the completed forms back to our secure fax (941-366-0134) or mail them to CCC/Attn: Care Connection Team, 1231 N. Tuttle Ave, Sarasota, FL 34237. If you prefer to send these forms to us electronically, please email careconnectionteam@cccsrq.org.

If you are unable to complete these forms prior to your visit, please arrive at least 15 minutes in advance of your appointment to complete them in our office.  Thank you again for choosing Comprehensive Care Center to provide your care.

Please Click here to Download the New Patient Forms

Comprehensive Care Center, Inc., a not-for-profit, section 501©(3), REG. #CH4241

Donor Privacy Policy: Comprehensive Care Center, Inc. will not share, sell or trade donor information under any circumstances nor send donor mailings on behalf of other organizations.

Comprehensive Care Center, Inc. is proud to comply with all applicable laws and regulations regarding solicitations of contributions in Florida under registration #CH4241: A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.

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