Extended Life Wellness Center Inc

1418 South Federal Hwy. Dania Beach Florida 33004
        (N.W Corner of US1 and Sheridan Street)
      Telephone: 954.921.9555 Fax: 954.921.9556

Dania Beach Patient Enrollment in Clinic

New Patient Application


Sometimes, patient enrollment can be such a hassle, so speed Up the patient enrollment process by filling the form above prior to your visit. This information is kept confidential and only your direct physician will have access to this information. If you rather fill this information at our clinic, you are more than welcome to do so.

If you have any questions, please contact us.


Service Provided


Family Practice

Chronic Pain Syndrome

Shoulder and Arm Pain

Neck Pain Sports Injuries

Low Back Pain Diabetic Pain

Chronic Abdominal Pain Osteoarthritis

Back Pain

Neck Pain

Herniated Discs

EMC Emergency Medical Condition

Personal Injury Protection Physicians office for immediate assistance.


Eligibility Requirements


  •                                                                                   Florida Resident with ID (Driver's License or ID)
  •                                                                                                  23 years of age or older
  •                                                                                              MRI or CAT Scan within 2 years
  •                                                                                       Referral from a primary care physician
  •                                                                                Records from previous pain management facility

  • IMPORTANT NOTE:
    Note to patients:

    In the event of a medical emergency, call 911. Patients with other medical problems should contact Extended Life Wellness directly during regular office hours. In the event that a problem occurs after office hours Life Extension Wellness Center Answering Service 954.921.9543


  • If you are a new patient, please bring ID and insurance card information with you to your appointment. If you have been referred to us by another doctor, please bring your referral with you. If you already have an appointment scheduled, you can submit a request to reschedule here.

    If your appointment time is less than 24 hours notice, or for any other questions on patient enrollment, please contact the office at: 954.921.9555