Patient Portal

Tebra Patient Portal

Existing patients can use the secure Tebra patient portal to manage their care online, any time.

What you can do in the portal

• View upcoming appointments
• View your account balance
• View itemized receipts
• View current prescriptions
• View medical notes
• View lab results
• Send a secure message to our staff

If you have trouble logging in, call our office at 321.406.0001 and we’ll be glad to help.

Request Portal Access

Don’t have a portal account yet? Request an invitation below. Our staff will check your information against our records and, if it matches, Tebra will email you an invitation to set up your account.

Patient Forms

Central Florida UroGynecology — M. Sprock, M.D.

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What do you need help with?

What can we help you with?

Patient Portal AccessRequest an invitation to our secure patient portal.

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Who is requesting these records?

Who is requesting these records?

I am the patient Someone else, on the patient's behalf (attorney, other medical office, insurer, etc.)

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Your Information

First name

Last name

This is your contact information as the requester. We'll ask for the patient's information next.

Company / organization name

Date of birth

Month Day Year

Email Enter the email you want to use for the portal. If it's different from the one we have on file, you can tell us on the next page.

Phone

🇺🇸 +1 Other

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Details

Chief complaint Primary insurance Loading...

Insurance name

Primary policy ID Do you have secondary insurance?

Yes No

Secondary insurance Select...

Insurance name

Secondary policy ID

Preferred day Select... No preference Monday Tuesday Wednesday Thursday Friday Preferred time frame Select... Morning (8:00 – 10:00) Mid-morning (10:00 – 12:00) Afternoon (12:00 – 2:00) Late afternoon (2:00 – 4:00) Upload documents PDF or image files accepted (up to 10 files, max 10MB each)

I confirm that I am authorized to communicate regarding the HIPAA-protected information in this request.

I declare that the information I have provided is accurate and complete.

Yes, Central Florida UroGynecology may text me at the phone number I provided about my care and account, such as appointment reminders, scheduling, forms and billing. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for help. Agreeing is optional and not a condition of care. See our Privacy Policy and Terms.

Chief complaint Primary insurance Loading...

Insurance company name

Primary policy ID Do you have secondary insurance?

Yes No

Secondary insurance Select...

Insurance company name

Secondary policy ID

Upload insurance card PDF or image files accepted (up to 10 files, max 10MB each) — e.g. front and back of an insurance card

I confirm that I am authorized to communicate regarding the HIPAA-protected information in this request.

I declare that the information I have provided is accurate and complete.

Before you submit

• Your information must match our records. We only send an invitation once the name, date of birth, and email you entered match what we have on file.
• Using a different email than the one we have on file? Check the box below. To protect your records, we'll call you at the phone number on file to confirm before we change it.
• Already use this email at another practice on Tebra? Each email can be used on only one Tebra portal account. Add a plus sign and a tag before the @, like jane.doe+cfug@gmail.com, enter that address above, and check the box below. Mail to it still arrives in your normal inbox.
• Watch for an email from Tebra. After our staff review your request, the invitation comes from Tebra, our patient portal provider, not from our office. Please wait for it, and check your spam folder.

This is a new email address. Please update my record (you'll call the phone number on file to confirm first).

I understand an invitation is only sent once my information is confirmed against your records.

What's this about? Select... Appointment Prescriptions Symptoms / Medical Question Other What's your question? Upload a document (optional) PDF or image files accepted (up to 10 files, max 10MB each)

I confirm that I am authorized to communicate regarding the HIPAA-protected information in this request.

I declare that the information I have provided is accurate and complete.

Type of question Select... Account balance Statement question Insurance claim Payment plan Refund request Other Describe your question What action would you like us to take? Upload EOB or documents PDF, images, or Word documents accepted (up to 10 files, max 10MB each)

I confirm that I am authorized to communicate regarding the HIPAA-protected information in this request.

I declare that the information I have provided is accurate and complete.

Get your records free in the patient portal

Your complete medical record is available at no cost in our secure patient portal. You can view it, save it, or send it to another doctor yourself, any time.

Log in to the patient portal

No portal account yet? Choose the first option below and submit. We'll email you a portal invitation and a step-by-step guide to downloading your full record.

What do you need?

Free — Send me a portal invitation and the download guide Free — Send my records to another provider for my continuing care Fee applies — Send a copy to me, an attorney, SSA, VA, a disability office, or anyone else who isn't treating me

Fees apply. Our office will confirm the amount, based on your request, before releasing records. Records are sent electronically only, by secure email or fax. Getting your records yourself through the patient portal is always free.

Step 1: Print, sign, and scan the release form

We need a release form signed by hand (a typed or electronic signature can't be accepted). Download it, print it, fill it out, sign it in ink, then scan it or take a clear photo of every page.

Download the Continuing Care release form (PDF) Download the Medical Records Release form (PDF)

Send records to

Me, by secure email Someone else, by fax or secure email

Provider Receiving Your Records

Provider / facility name Fax number Location / address Phone number

Other Contact Details

Contact name Phone number Fax number Email Enter a fax number or an email address. We don't send paper copies.

Step 2: Upload your hand-signed release form Scan (PDF) or photo (JPG/PNG) of every signed page — up to 10 files, max 10MB each Anything else you'd like us to know? (optional)

I confirm that I am authorized to communicate regarding the HIPAA-protected information in this request and that the uploaded release form has been signed by hand by the patient or authorized representative.

I understand fees apply to this request, that the office will confirm the amount, and that payment is due before records are released, and that I can get my records free through the patient portal instead.

Reason for this records request Upload your authority to request these records Signed patient authorization, subpoena, court order, or similar (up to 10 files, max 10MB each)

Patient Information

Whose records are you requesting?

Patient first name

Patient last name

Patient date of birth

Month Day Year

Anything else you'd like us to know? (optional)

I confirm that I am legally authorized to request these medical records and that the uploaded document supports this request.

Document type

Insurance Card (Front & Back) New Patient Paperwork Existing Patient Paperwork Lab Results Other

Description of document(s) Upload scanned document(s) PDF or image files accepted (up to 10 files, max 10MB each) — select both sides if uploading an insurance card Anything else you'd like our office to know?

I confirm that I am authorized to communicate regarding the HIPAA-protected information in this request.

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Patient Portal FAQ

How long until I get my invitation?

Our staff review each request and send the invitation once your information is confirmed. It comes from Tebra, our patient portal provider, not from our office. Please wait for it, and check your spam or junk folder. If it’s been a few business days, submit a new request using the form above.

Why didn’t I get an invitation?

We only send an invitation once the name, date of birth, and email you entered match what we have on file. If you’re not sure which email we have, enter the one you want to use and check the new-email box in the form above.

Can I change my email with the request form?

Yes. Enter the new email in the form above and check the box saying it’s a new address. To protect your records, we’ll call you at the phone number we have on file to confirm before we change it.

My email is already used at another practice that uses Tebra. What do I do?

Tebra allows each email address on only one portal account, even across different practices. Most email providers let you add a plus sign and a tag right before the @ sign, and mail sent to that address still arrives in your normal inbox. For example, jane.doe@gmail.com becomes jane.doe+cfug@gmail.com.

Request your invitation in the form above using the tagged address, and check the new-email box. We’ll call the phone number on file to confirm, then send the invitation.

Does the plus-sign trick work with my email?

It works with most providers, including Gmail, Outlook, Hotmail, iCloud, and Proton Mail. If yours doesn’t support it, you can use a different email address instead. Request it the same way, with the new-email box checked.