Patient Forms

If you need support to complete these forms or have any questions, please call or text us at 305-902-6347 Monday-Friday from 8:30 am - 6:00 pm ET.

 

Consent Form

Please complete the following form before your upcoming appointment. If we do not have this form 24 hours before your appointment, we may need to reschedule the appointment.
Complete Form

Release of Information

Please complete the following form before your upcoming appointment. If we do not have this form 24 hours before your appointment, we may need to reschedule the appointment.
Complete Form

Request a Refill

To request a medication refill online, fill out the form at the link provided. Refills can take up to 5 business days to process (not including weekends and holidays) and are sent directly to the pharmacy. You may also call 305-902-6347 and press 4.
Request a Refill

Intake Assessment

Medication Management patients may be asked to complete this form before your first appointment. 
Complete Form

Current Patients: Next Appointment Request

If you are a current patient, you may request a new appointment using this form. 
Complete Form

Long Acting Injectable Patient Treatment Agreement

In certain circumstances, Brave Health patients may be appropriate candidates for Long Acting Injectable medications.
Complete Form
(305) 902-6347
Mailing Address
1951 NW 7th Ave, FL 3
Miami, FL 33136
If you experience a mental health emergency at any time, contact the Suicide and Crisis Lifeline by calling or texting 988.
© 2023 Brave Health, Inc., Brave Health Medical Group, PA, and Brave Medical, PC are independent, affiliated organizations. The organization providing clinical services is dependent on the state of residence of the patient.