For State Farm please use the following forms



All TeleEMC State Farm patients are now being referred to OrthoMiami (https://www.orthomiami.com): Dr.Cesar E. Ceballos, MD and his exceptional staff.

The OrthoMiami staff is available to assist you, and your patients in completing required documentation, or connecting with the OrthoMiami’s physicians via telemedicine on the Doxy.me platform. Progress notes will be sent to your office immediately, as you have been accustomed to.

Ortho Miami’s office is open from 8 AM to 7 PM Monday thru Thursday, and 8 AM to 2 PM on Friday

If you need any further assistance please contact Ortho Miami at (305)596-2828 ext: 121 and reference that you are calling about an EMC.

State Farm EMC Forms

 

Download Forms

PIP EMC Form
Download printable PDF of the paperwork (Español)

Online Forms

EMC Registration FormOrtho Miami New Patient Packet online (Español)

Forms W/O EMC

Download Form

PIP EMC Form
Download printable PDF of the paperwork (Español)

Online Form

EMC Registration FormOrtho Miami New Patient Packet online (Español)

Minor Consent

EMC Form
Click for Minor Children EMC Patient Form