{"id":1681,"date":"2020-03-15T11:29:37","date_gmt":"2020-03-15T16:29:37","guid":{"rendered":"https:\/\/teleemc.com\/?page_id=1681"},"modified":"2026-08-14T18:48:44","modified_gmt":"2026-08-14T23:48:44","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/teleemc.com\/?page_id=1681","title":{"rendered":"Patient Forms"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.4.1&#8243;][et_pb_row column_structure=&#8221;1_2,1_2&#8243; _builder_version=&#8221;4.4.1&#8243;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.4.1&#8243;][et_pb_cta title=&#8221;Download Form&#8221; button_url=&#8221;https:\/\/teleemc.com\/wp-content\/uploads\/TeleEMC-registration-doc-05-2019d.pdf&#8221; url_new_window=&#8221;on&#8221; button_text=&#8221;Click Here&#8221; _builder_version=&#8221;4.5.1&#8243; background_color=&#8221;rgba(12,113,195,0.13)&#8221; background_layout=&#8221;light&#8221;]<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/teleemc.com\/wp-content\/uploads\/hand-filling-out-form-GettyImages-889512880.jpg\" width=\"500\" height=\"338\" alt=\"PIP EMC Form\" title=\"PIP EMC Form\" class=\"wp-image-1664 alignnone size-full\" \/><br \/>\nDownload printable PDF of the paperwork (<a href=\"\/wp-content\/uploads\/TeleEMC_Registration_Documents_sp.pdf\">Espa\u00f1ol<\/a>|<a href=\"\/wp-content\/uploads\/TeleEMC_Registration_Documents_kr.pdf\">Krey\u00f2l<\/a>)<\/p>\n<p>[\/et_pb_cta][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.4.1&#8243;][et_pb_cta title=&#8221;Online Form&#8221; button_url=&#8221;https:\/\/teleemc.com\/?page_id=1764&#8243; button_text=&#8221;Click Here&#8221; _builder_version=&#8221;4.5.1&#8243; background_color=&#8221;rgba(12,113,195,0.13)&#8221; background_layout=&#8221;light&#8221; link_option_url=&#8221;https:\/\/teleemc.com\/?page_id=1764&#8243; hover_enabled=&#8221;0&#8243; global_module=&#8221;1690&#8243;]<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/teleemc.com\/wp-content\/uploads\/patient_forms_1.jpg\" width=\"500\" height=\"338\" alt=\"EMC Registration Form\" title=\"EMC Registration Form\" class=\"wp-image-1669 size-full\" \/>\u00a0TeleEMC new patient paperwork online (<a href=\"https:\/\/teleemc.com\/?page_id=2482\">Espa\u00f1ol<\/a>|<a href=\"https:\/\/teleemc.com\/?page_id=2487\">Krey\u00f2l<\/a>)[\/et_pb_cta][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=&#8221;4.5.1&#8243; module_alignment=&#8221;center&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.4.1&#8243;][et_pb_cta title=&#8221;Minor Consent&#8221; button_url=&#8221;https:\/\/teleemc.com\/Minor%20Authorization%20Form.pdf&#8221; button_text=&#8221;Click Here&#8221; _builder_version=&#8221;4.5.1&#8243; background_color=&#8221;rgba(12,113,195,0.13)&#8221; button_alignment=&#8221;center&#8221; background_layout=&#8221;light&#8221; link_option_url=&#8221;https:\/\/teleemc.com\/Minor%20Authorization%20Form.pdf&#8221; hover_enabled=&#8221;0&#8243;]<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/teleemc.com\/wp-content\/uploads\/patient_forms_3.jpg\" width=\"500\" height=\"338\" alt=\"EMC Form\" title=\"EMC Form\" class=\"wp-image-1668 size-full\" \/> <br \/>Click for Minor Children EMC Patient Form[\/et_pb_cta][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.5.1&#8243; _module_preset=&#8221;default&#8221;][et_pb_row _builder_version=&#8221;4.5.1&#8243; _module_preset=&#8221;default&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.5.1&#8243; _module_preset=&#8221;default&#8221;][et_pb_code _builder_version=&#8221;4.5.1&#8243; _module_preset=&#8221;default&#8221;]<script><!-- [et_pb_line_break_holder] -->  setTimeout(function() {<!-- [et_pb_line_break_holder] -->\t    $('#patformdiv').show();<!-- [et_pb_line_break_holder] -->    },1500);<!-- [et_pb_line_break_holder] --><\/script>[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; fullwidth=&#8221;on&#8221; _builder_version=&#8221;4.4.1&#8243;][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;footer row&#8221; _builder_version=&#8221;3.24&#8243; background_color=&#8221;rgba(12,113,195,0.13)&#8221; min_height=&#8221;260px&#8221; custom_margin=&#8221;16px|||||&#8221; custom_padding=&#8221;||0px|||&#8221; global_module=&#8221;943&#8243; saved_tabs=&#8221;all&#8221;][et_pb_row column_structure=&#8221;1_3,1_3,1_3&#8243; admin_label=&#8221;2nd row of footer&#8221; _builder_version=&#8221;3.25.3&#8243; 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icon_font_size=&#8221;18px&#8221; admin_label=&#8221;Call Us Blurb&#8221; _builder_version=&#8221;3.27.3&#8243; header_font=&#8221;Work Sans|600||on|||||&#8221; header_text_color=&#8221;#005EAB&#8221; header_font_size=&#8221;14px&#8221; header_letter_spacing=&#8221;2px&#8221; header_line_height=&#8221;1.2em&#8221; body_font=&#8221;Work Sans||||||||&#8221; body_line_height=&#8221;1.8em&#8221; custom_margin=&#8221;||-40px&#8221; animation=&#8221;off&#8221; body_font_size_tablet=&#8221;16px&#8221; body_font_size_phone=&#8221;14px&#8221; body_font_size_last_edited=&#8221;off|phone&#8221; locked=&#8221;off&#8221; body_font_size__hover=&#8221;14px&#8221; body_font_size__hover_enabled=&#8221;14px&#8221;]<\/p>\n<p><span style=\"color: #000000;\"><a href=\"tel:866-611-4362\" style=\"color: #000000;\">(866) 611-4EMC<\/a><br \/> <a href=\"tel:866-611-4362\" style=\"color: #000000;\">(866) 611-4362<\/a><\/span><\/p>\n<p>[\/et_pb_blurb][\/et_pb_column][et_pb_column type=&#8221;1_3&#8243; _builder_version=&#8221;3.25&#8243; 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_builder_version=&#8221;3.25.3&#8243; custom_padding=&#8221;141px|||&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_blurb title=&#8221;Our Location&#8221; url=&#8221;https:\/\/goo.gl\/maps\/UqXZSzmSux6FAVtx7&#8243; use_icon=&#8221;on&#8221; font_icon=&#8221;%%249%%&#8221; icon_color=&#8221;#005EAB&#8221; icon_placement=&#8221;left&#8221; content_max_width=&#8221;100%&#8221; use_icon_font_size=&#8221;on&#8221; icon_font_size=&#8221;18px&#8221; admin_label=&#8221;Address\/map&#8221; _builder_version=&#8221;4.5.1&#8243; header_font=&#8221;Work Sans|600||on|||||&#8221; header_text_color=&#8221;#005EAB&#8221; header_font_size=&#8221;14px&#8221; header_letter_spacing=&#8221;2px&#8221; header_line_height=&#8221;1.2em&#8221; body_font=&#8221;Work Sans||||||||&#8221; body_line_height=&#8221;1.8em&#8221; custom_margin=&#8221;-137px||&#8221; animation=&#8221;off&#8221; body_font_size_tablet=&#8221;16px&#8221; body_font_size_phone=&#8221;14px&#8221; body_font_size_last_edited=&#8221;off|phone&#8221; locked=&#8221;off&#8221; body_font_size__hover=&#8221;14px&#8221; body_font_size__hover_enabled=&#8221;14px&#8221;]<span style=\"color: #000000;\">P.O. Box 286154<\/span><br \/>\n<span style=\"color: #000000;\">Tampa, FL 33630-6154<\/span>[\/et_pb_blurb][et_pb_blurb title=&#8221;Hours&#8221; use_icon=&#8221;on&#8221; font_icon=&#8221;%%227%%&#8221; icon_color=&#8221;#005EAB&#8221; icon_placement=&#8221;left&#8221; content_max_width=&#8221;100%&#8221; use_icon_font_size=&#8221;on&#8221; icon_font_size=&#8221;18px&#8221; admin_label=&#8221;Hours Blurb&#8221; _builder_version=&#8221;3.24&#8243; header_font=&#8221;Work Sans|600||on|||||&#8221; header_text_color=&#8221;#005EAB&#8221; header_font_size=&#8221;14px&#8221; header_letter_spacing=&#8221;2px&#8221; header_line_height=&#8221;1.2em&#8221; body_font=&#8221;Work Sans||||||||&#8221; body_line_height=&#8221;1.8em&#8221; custom_margin=&#8221;-16px||&#8221; animation=&#8221;off&#8221; body_font_size_tablet=&#8221;16px&#8221; body_font_size_phone=&#8221;14px&#8221; body_font_size_last_edited=&#8221;off|phone&#8221; locked=&#8221;off&#8221; body_font_size__hover=&#8221;14px&#8221; body_font_size__hover_enabled=&#8221;14px&#8221;]<\/p>\n<p><span style=\"color: #000000;\">M-F 8am &#8211; 7pm<\/span><br \/> <span style=\"color: #000000;\"> Sat\u00a0 8am &#8211; 4pm<\/span><\/p>\n<p>[\/et_pb_blurb][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.4.1&#8243;][et_pb_row column_structure=&#8221;1_2,1_2&#8243; _builder_version=&#8221;4.4.1&#8243;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.4.1&#8243;][et_pb_cta title=&#8221;Download Form&#8221; button_url=&#8221;https:\/\/teleemc.com\/wp-content\/uploads\/TeleEMC-registration-doc-05-2019d.pdf&#8221; url_new_window=&#8221;on&#8221; button_text=&#8221;Click Here&#8221; _builder_version=&#8221;4.5.1&#8243; background_color=&#8221;rgba(12,113,195,0.13)&#8221; background_layout=&#8221;light&#8221;] Download printable PDF of the paperwork (Espa\u00f1ol|Krey\u00f2l) [\/et_pb_cta][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.4.1&#8243;][et_pb_cta title=&#8221;Online Form&#8221; button_url=&#8221;https:\/\/teleemc.com\/?page_id=1764&#8243; button_text=&#8221;Click Here&#8221; _builder_version=&#8221;4.5.1&#8243; background_color=&#8221;rgba(12,113,195,0.13)&#8221; background_layout=&#8221;light&#8221; link_option_url=&#8221;https:\/\/teleemc.com\/?page_id=1764&#8243; hover_enabled=&#8221;0&#8243; global_module=&#8221;1690&#8243;]\u00a0TeleEMC new patient paperwork online (Espa\u00f1ol|Krey\u00f2l)[\/et_pb_cta][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=&#8221;4.5.1&#8243; module_alignment=&#8221;center&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.4.1&#8243;][et_pb_cta title=&#8221;Minor Consent&#8221; button_url=&#8221;https:\/\/teleemc.com\/Minor%20Authorization%20Form.pdf&#8221; button_text=&#8221;Click Here&#8221; _builder_version=&#8221;4.5.1&#8243; background_color=&#8221;rgba(12,113,195,0.13)&#8221; button_alignment=&#8221;center&#8221; background_layout=&#8221;light&#8221; [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-1681","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/teleemc.com\/index.php?rest_route=\/wp\/v2\/pages\/1681","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/teleemc.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/teleemc.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/teleemc.com\/index.php?rest_route=\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/teleemc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1681"}],"version-history":[{"count":33,"href":"https:\/\/teleemc.com\/index.php?rest_route=\/wp\/v2\/pages\/1681\/revisions"}],"predecessor-version":[{"id":3007,"href":"https:\/\/teleemc.com\/index.php?rest_route=\/wp\/v2\/pages\/1681\/revisions\/3007"}],"wp:attachment":[{"href":"https:\/\/teleemc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1681"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}