Patient Information

What to Bring to Your Appointment | Patient Forms
Insurance and Payment Information | Affiliated Hospitals

What to Bring to Your Appointment

• Your insurance card
• Physician referral forms, if required by insurance
• List of prescriptions and/or over-the-counter medication, including dose and frequency
• Information about your medical and surgical history
• Recent x-rays or relevant records

Patient Forms

Please print out and complete the following patient form and bring it to your appointment:

Patient History Form (PDF) [PDF help]
Please complete only the sections of the form marked with yellow headers

Insurance and Payment Information

Santiago Martinez, M.D., is a provider for Medicare and most major insurance plans, and provides insurance billing. You are responsible for charges that are not covered by your insurance, at the time of your appointment.

Your insurance company may require a co-payment at the time of your appointment. When necessary, our staff will work with patients to set up a payment plan.

If you have questions regarding billing or which insurance plans we accept, please call us at the phone number below. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

Affiliated Hospitals

• Florida Hospital
• Orlando Regional Medical Center
• Winter Park Hospital
• South Lake Hospital
• Health Central

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Santiago Martinez, M.D.
www.smartinez.net