Jane Fischer, DNP, APRN

Dermatology

5350 University Parkway, Suite 200
Sarasota, FL 34243
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Phone: (941) 917-8300

Fax: (941) 917-4023

Education: University Florida, Gainesville, Florida

Certifications: American Academy of Nurse Practitioners; Adult, Family, and Dermatology NP, Board Certified

Print Your Forms and Save Time

Please read in full prior to completing paperwork

New Patient Letter

Print & complete documents 1-5

1. Dermatology Health History Questionnaire

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 office

Reference Documents

1. Notice of Privacy Practices

2. Making Personal Choices Infomation

3. Living Will Documentation

FPG Navigator

A password-protected Web portal that gives you 24-hour access to certain personal health information from your FPG medical record. For urgent requests, phone your doctor’s office. Call 911 for emergencies.

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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