Jorge Glass, MD Office and Other Patient Information
Primary Office
Office 1: Baptist Pulmonary Specialists
, Fernandina Beach, FL 32034
(904) 261-9911
Patient Forms
Welcome to Baptist Pulmonary Specialists. To help expedite your first visit, we provide our health forms online so that you can print and complete them at your convenience. If you have any questions, please don’t hesitate to contact our office staff.
Baptist Pulmonary Specialists Forms
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Medical Records Release
Request to have your medical records sent to another medical provider.
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Pulmonary Current Symptoms Form
At each visit, you’ll be asked to complete this quick form about any current symptoms you may.
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Pulmonary Past History Review Form
Provides the physician with important information about your medical and family history to better diagnose, treat or prevent conditions.
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Pulmonary Patient Medical History Form
Medication list and past medical history