Forms & Payment

Accepts new patients

Medicare Medicaid Workers' compensation Other
Yes No Yes Yes

Medical insurance plans and payment options

Bennett Orthopedics & Sportsmedicine Accepts: Almost all Private Insurance Plans Personal Injury Auto Accidents Worker's Compensation

Payment Plan acceptable for cash paying patients

Office information from William F Bennett, MD

J.) HIPPA POLICY
Full HIPPA Policy

(A) New Patient - NonShoulder - Private
Fill out the this form if you have Private Insurance, Cash Payer, or Work Comp. Case...... Please fill/sign all forms and bring them with you at the time of your appointment, or email them to bennettorthopedics2@verizon.net. Thank you, and we look forward to seeing you.

(B) New Patient - Shoulder - Private
Fill out the this form if you have Private Insurance, Cash Payer, or Work Comp. Case and have a Shoulder Injury...... Please fill/sign all forms and bring them with you at the time of your appointment, or email them to bennettorthopedics2@verizon.net. Thank you, and we look forward to seeing you.

(C) New Patient - NonShoulder - Medicare
Fill out the this form if you have Medicare...... Please fill/sign all forms and bring them with you at the time of your appointment, or email them to bennettorthopedics2@verizon.net. Thank you, and we look forward to seeing you.

(D) New Patient - Shoulder - Medicare
Fill out the this form if you have Medicare and a Shoulder Injury...... Please fill/sign all forms and bring them with you at the time of your appointment, or email them to bennettorthopedics2@verizon.net. Thank you, and we look forward to seeing you.

(E) New Patient - NonShoulder - Auto/P.I.
Fill out the this form if this is an Auto or Personal Injury Case...... Please fill/sign all forms (have all adjuster/telephone/claim number information listed)and bring them with you at the time of your appointment, or email them to bennettorthopedics2@verizon.net. Thank you, and we look forward to seeing you.

(F) New Patient - Shoulder - Auto/P.I.
Fill out the this form if this is an Auto or Personal Injury Case and have a Shoulder Injury...... Please fill/sign all forms (have all adjuster/telephone/claim number information listed)and bring them with you at the time of your appointment, or email them to bennettorthopedics2@verizon.net. Thank you, and we look forward to seeing you.

G.) Employment Application (Non-Clinical)
Employment application for non-clinical positions.

H.) Employment Application (Clinical)
Employment application for clinical positions.

I.) Definition of Usual Customary and Reasonable Fees
Definition of the term usual Customary and reasonable fees.

Contact Information

Bennett Orthopedics & Sportsmedicine 1250 S. Tamiami Tr Suite 303 Sarasota, Fl USA 34239 View map Phone 941-953-5509 Fax 941-953-5510

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