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New Port Richey
G.S. Dhaliwal, M.D.
Primary Care Walk In Clinic
6329 State Road 54
New Port Richey, FL 34653

Phone: 727.844.5555
Fax: 727.844.5550

Spring Hill
G.S. Dhaliwal, M.D.
Primary Care Walk In Clinic
11123 County Line Road
Spring Hill, FL 34609

Phone: 352.666.5555
Fax: 352.666.2915


Forms

(1a)

Demographic Sheet:  (Click here for file )
Print - Complete - Fax/Bring with you to office visit.

(1b)

Medication sheet:  (Click here for file)

(1c)

Questionnaires:  (Click here for file)

(2)

Primary Care Walk In Clinic as participating provider: (Click here for file)
Print - Complete application and mail to your insurance company.

(3)

HIPAA Policy:  (Click here for file)

(4)

Consent form to request Medical Records: (Click here for file)

(5)

Consent form for Flu Shot: (Click here for file)

(6)

Consent form for Pneumonia Shot: (Click here for file)

(7)

Insurance List (Click here for file)