Patient Information & Forms

Thank you for choosing Ally Healthcare. To make your visit as efficient and thorough as possible, please review the following information before your visit to our Temple Terrace, FL, office.

Accepted Insurances

We accept the following insurance plans. If you have any questions about your coverage, please contact our office.

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Humana Gold Plus

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Optimum

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Freedom

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Medicare

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United Healthcare (Wellmed)

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Tricare for Life

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Blue Cross Blue Shield (BCBS) (not HMO Select)

Community Resources Links

Coming Soon

Patient Education Links

Coming Soon

Patient Forms

Please print and complete the appropriate forms prior to your visit. The forms include registration, authorization for release of information, new patient questions, permission for treatment, medication list, referrals, your rights as a patient, an introductory letter, and medical history. Pilots should review the pilot guideline form.

All Patients

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All Forms

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Patient Registration

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Authorization to Release Information

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New Patient Questionnaire

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Permission for Treatment

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Patient Medication Sheet

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Referral Process

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Patient Bill of Rights

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Letter to Patients

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Medical History

For Pilots

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Pilot Guidelines

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Link to MedXPress

If you have any questions about your insurance or patient forms, call 813-200-7717 or contact us to speak with us.

Contact

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Fax
813-985-8500

Hours

Monday -Thursday 8:00 AM - 5:30 PM (Closed for Lunch 12:30 PM - 1:30 PM)
Friday - 8:30 AM - 5:00 PM
Friday Walk-In - 8:30 AM - 4:00 (Every 3rd Friday of Each Month, Clinic Closes at 12:30 PM)