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.
Download our Brochures:
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.
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.