1891 Beach Blvd., Suite 200
Jacksonville Beach, FL 32250

Phone: 904.249.3743
Fax: 904.249.2047

Clinic Hours:

Mon – Thurs: 7:30 a.m. – 5:00 p.m.
Frid: 7:30 a.m. – 12:00 p.m.

Patient Forms

Welcome and thank you for choosing Dr. Randolph’s Ageless and Wellness Medical Center. We want to do everything we can to address your health care needs and make your visit comfortable and convenient. You will need to complete a number of forms prior to your  visit in order for us to get an accurate assessment of your health concerns. Please LOGIN to the Patient Portal to fill out your form prior to your appointment.

For your appointment, please bring:

  • Insurance card
  • Driver’s license
  • Any necessary referrals
  • Completed paperwork, if not sent in advance


If your paperwork is sent in advance we ask that you arrive 20 minutes before your scheduled appointment time to process your health insurance. Please contact our office at (904) 249-3743 if you have any questions. Thank you and we look forward to seeing you soon!