New patients: start with the intake form

Jerzy Grzebieluch, MD

Jan 1, 2024

2 min read

Updated: Oct 19

Your first step

If you are new to my Fort Walton Beach practice, begin on the New Patients page. Choose the coverage option that fits you and complete the secure intake form. Our office reviews your form, verifies coverage, and calls you within one business day to schedule your appointment. You do not need to call after submitting; if you do not hear from us, call (850) 864-2008.

Choose your coverage before opening the form

1. TRICARE is my primary insurance. Active-duty family members use this option.

2. Medicare + TRICARE For Life. Our office reviews this coverage arrangement separately.

3. Self-pay / arranged with our office. Use this option if the office has arranged it with you.

4. Commercial insurance is my primary insurance. Please call (850) 864-2008 before completing forms. Our office is not in-network with commercial insurance plans. If commercial insurance is primary and TRICARE is secondary, visits are self-pay; our office cannot bill TRICARE as secondary. We welcome active-duty family members. Service members on active duty, including activated Guard and Reserve members, should arrange care through their military treatment facility. Our office does not schedule those members.

TRICARE authorizations

Our office handles TRICARE authorizations for you. We verify your coverage and obtain any required authorizations for care provided by our practice. You do not need to arrange them yourself.

What happens after the form?

Our office reviews the form and calls you to schedule or explain anything that prevents scheduling. At the appointment, I personally evaluate your concerns, discuss my findings and plan the next steps with you. Submitting the form does not reserve an appointment.

Phone: (850) 864-2008 · Fax: (850) 864-5008.