Patient Consent Form

If you or your loved one are beginning the process of receiving services from Gulfside, click the button above to electronically complete the necessary forms. All information submitted is secure and will be sent to Gulfside's team immediately.

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Download our Brochures:

Hospice Brochure

Home Health Brochure

Palliative Care Brochure

Folleto de hospicio en español

Folleto de salud en el hogar en español

HIPAA Privacy

Florida Medicaid Hospice Services Election Form

Medicare Election of Benefit Form

Medical Information Release Authorization Form

Authorization for Access to Protected Health Information Notice (English)
Authorization for Access to Protected Health Information Form (English)
 
Authorization for Access to Protected Health Information Notice (Spanish)
Authorization for Access to Protected Health Information Form (Spanish)

Gulfside's Center Admission Agreement

Patient Bill of Rights


For more information or assistance with any of the above forms, please contact Gulfside's Admissions Team at 800-561-4883.