Request an Estimate

This form will be utilized for patients to make a request for an estimate of medical services. Utilizing this form will assist by making the process more efficient and allow Parrish Medical Center to efficiently track your request. Please complete the form in its entirety by submitting the requested information. If you are not the patient requesting the information (except on the behalf of a minor) you will need a Power of Attorney at the time of submission of this document or a Release of Information form.

Parrish Medical Center offers two ways to file a "Request for Estimate."


Option 1:

Fill in the following form

Denotes Required Field

Patient Information












Physician Information





Option 2:

Fill out the document below and mail to Parrish Medical Center

Request an Estimate PDF

Request for an estimate of charges are for hospital services only. The estimate does not include the reading or interpretation or the examination, which may be required. This is a good faith estimate based on the current Charge Master and an average of previous procedures performed at Parrish Medical Center.

Parrish Healthbridge: Healthcare Simplified

For education, breaking news or a message from your physician, HealthBridge will get it to you quickly.

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Our Services

PMC helps our community stay healthy by living our vision of Healing Families—Healing Communities®

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Classes & Events

Get healthy—and stay that way!—with dozens of classes, events and support groups to choose from every month.

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Accomplishments

Parrish Medical Center is among the nation's best in clinical care, safety and patient experiences.

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Patient Stories

Need a little get-healthy inspiration? Read about how people just like you have transformed their lives.

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Web Nursery

Parents of babies born at PMC can choose to have a picture of their baby posted.

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Online Scheduling

Parrish Medical Center lets you reserve a space at urgent care centers and the hospital's ER.

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