Dennis Charette, MD

Family Practice

2345 Bobcat Village Center Rd., Ste. 202
North Port, FL 34288
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Phone: (941) 257-2930

Fax: (941) 257-2923

Education: Marshall University, Huntington, WV

Residency: Marshall University Medical Center, Huntington, WV

Certifications: American Board of Family Practice

Print Your Forms and Save Time

Please print & complete documents 1-5

1A. Adult Health History Questionnaire

or

1B. Pediatric Health History Questoinnaire

2. New Patient Registration

3. Consent for Treatment

4. Consent to Leave Messages

5. Authorization to Release Medical Records

*Some additional paperwork must be completed at the office

Medicare Annual Wellness Visit

1. Health Risk Assessment (HRA)

Reference Documents

1. Notice of Privacy Practices

2. Making Personal Choices Information

3. Living Will Documentation

FPG Navigator

FPG Navigator will be unavailable from 8/10-8/26 while we transition to our New Patient Portal. For assistance, please contact your provider’s office.

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Contact

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact Sarasota Memorial Health Care System Public Relations Offices by phone or in writing:

ADMINISTRATION OFFICE:

1700 S. Tamiami Trail (mailing address); 1900 S. Tamiami Trail (physical address)

PRIVACY POLICY:

Please click here to read our Privacy Policy. | Nondiscrimination Statement

CONSUMER DATA:

Agency for Health Care Administration
Centers for Medicare / Medicaid Services