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Elizabeth A. Triana, M.D., FAAFP
All patients that are new to the Triana Prevention Center are required to fill out new patient forms. If you are a new patient we recommend you print out the necessary forms and fill them out in advance of your office visit. You may fax your completed forms to our office at 941-625-1991 before your scheduled appointment or you may bring your completed forms with you on your first visit.
Our forms require PDF Reader or WORD Reader. You can download Acrobat Reader or WORD Reader for free to view and print our forms.
New Patient PDF Forms
- New Patient Forms Packet (includes ALL forms)
- Patient Info and Consent
- Patient History
- Medical Records Release
- Records Copying Fee
- No Show Cancellation Fee
New Patient WORD Forms
- New Patient Forms Packet (includes ALL forms)
- Patient Info and Consent
- Patient History
- Medical Records Release
- Records Copying Fee
- No Show Cancellation Fee
If you have any questions regarding these forms please contact our office.
We accommodate same day appointments & accept many different health insurance plans. Contact us today & get on the road to good health. Your life depends on it!
LIVE RADIO SHOW!
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Dr. Triana also has a very informative live radio show that broadcasts on channel WCCF 1580 AM every Friday morning at 11:05-12:00. You can web-stream the broadcast live from www.wccfam.com or listen to previously recorded Radio Shows.
FAMILY PRACTICE
The Triana Prevention Center is conveniently located on Harbor Blvd. in Port Charlotte. Dr. Triana offers same day appointments and is accepting new patients.