Telemedicine Request

Request a telemedicine appointment with Dr. Sasha.

You have chosen to bill your Telemedicine Service to your insurance. By signing this form, you acknowledge that Dr. Sasha Noe and/or Apollo Beach Family Medical Center will file a claim for this service on your behalf to your health insurance plan.

TELEMEDICINE SCREENING CONSENT:

I have requested that Dr. Sasha provide a screening assessment for me regarding the condition agreed upon in my intake.

Via this screen, Dr. Sasha will provide me with feedback for my chief complaint. I acknowledge that this is not a Physician-Patient relationship or agreement. Neither Dr. Sasha nor any of her affiliates, physicians or employees shall have any liability or responsibility for the accuracy and completeness of the information that I provide to them.

By providing a screen assessment only and not as my Medical Doctor under this platform, Dr. Sasha does not assume any responsibility for my medical care or treatment.

For myself and my heirs, personal representatives, administrators, successors and assigns, I irrevocably release Dr. Sasha and its insurers, officers, directors, physicians, employees and affiliates from any and all known or unknown, foreseen and unforeseen, claims, actions, losses or damages arising in connection with this coaching program.

If you have questions regarding the cost related to this service, please contact our Office Coordinator at [email protected]

NOTE: Please do not use our contact information or form for medical emergencies, but rather call 911.

CALL US

+1 (813) 641-0007

Terms and conditions:

This form is only intended for the request of a telemedicine appointment with our office. We are not able to provide any medical advice through this form.

Once our staff receives the request, it will be processed and you will receive a call to confirm your appointment with our office.

Telemedicine Request

Please complete the form to request a telemedicine appointment with Dr. Sasha.

  • (0 = No Pain, 10 = Worst Pain Ever)
  • I acknowledge all of the information provided is accurate and I agree and consent to the Policies Outlined on this page.
  • This field is for validation purposes and should be left unchanged.

From Happy Patients

Testimonials

Excellent staff and doctor, very caring and professional. The doctor is very through and competent and has a very caring bedside manner. Both the doctor and the other providers are exceptional!

Natalie E.

Dr. Noe is a very caring loving doctor, she takes her time with me to make sure I understand everything she has said and answers ALL my questions without me feeling like she's rushing out the door. Her staff is is professional and they go out of their way to help me. Her receptionist is sweet and has gone out of her way several times to help me when I was in a bind. The office manager is very personable and I always see her running around helping out the staff. I am very grateful to have found this office for my family and highly recommend Dr. Noe to everyone!

Ashley B.

Excellent staff and doctor, very caring and professional. The doctor is very through and competent and has a very caring bedside manner. Both the doctor and the other providers are exceptional!

Natalie E.

Best experience with a doc and staff I have had 20 years! I highly recommend this clinic!

CJ C.

I am new to the area and found Dr. Sasha Noe and I'm so happy I did so! The receptionist are wonderful, very friendly genuine and real! The entire staff he's very genuine and warm and shows their concern for all. There is never a long wait and they are committed to seeing all patients in a timely manner

Cindy W.

The Apollo Beach Family Medical Center team provides medical care for everyone. In addition to meeting your medical needs, the Apollo Beach Family Medical Center offers a variety of other Health & Wellness programs.

CONTACT 

Phone number

813-641-0007

OFFICE HOURS

Monday-Friday: 8:30am - 4:30pm

Saturday: Closed

Sunday: Closed

Holidays: Closed