Forms

MEDICAL RELEASE FORM

To have medical records sent to us or to request your medical records, please fill out the Medical Release Form and fax to (321) 726-1610.

ELIGIBILITY AFFIDAVIT FORM

To receive medical services from L3HFMC, please fill out the Affidavit Form and fax to (321) 726-1610.

COUNSLOR NEW PATIENT FORM

For first-time patients of our Licensed Clinical Social Worker, please fill out the New Patient Form and fax to (321) 726-1610.

2021 FORMULARY

If you do not need a refill, but have a question or comment for the pharmacy, call (321) 726-1614 or email us at hfmcrx@mttcorp.com

The L3HFMC patient portal provides you with 24/7 access to your medical records, the ability to make an appointments online, send your provider a prescription refill request and other convenient tools to more effectively manage your health.

Members Have Access to:

You have access to Primary Care Physicians, an Onsite Lab, a Full Service Pharmacy, Mental Health services to include a Psychiatrist and Licensed Clinical Social Worker, Fitness Instructor, Health Coach/Dietician, and Diagnostic Imaging Center. You can either select an L3HFMC provider as your primary care physician for you and your loved ones or use the center for urgent care when necessary.

L3Harris Family Medical Center was established by L3Harris Technologies to provide high-quality, primary health care services.

Medical Technology Transfer Corporation based in Santa Monica, CA manages and operates L3HFMC and University Center Imaging. Operates in Melbourne, FL. 

L3Harris Family Medical Center is located at:

The Oaks Plaza
1800 West Hibiscus Boulevard,
Suite 101
Melbourne, Florida 32901

One block directly north of the Melbourne Square Mall

Clinic: (321) 726-1600
Pharmacy: (321) 726-1614
Wellness: (321) 409-4980