Appointment Line:
Call Us at: 972 258 7499

PATIENT FORMS

As a convenience to our patients we have gathered the following information and resource material that can be printed, completed and then mailed, fax’d or brought to our office. 

New Patients   

• Registration Form 
   
• Medical History Questionnaire 
   
• HIPAA   
   
• Please read our Privacy Policy, then complete this Acknowledgement of Receipt of Privacy Policy
   

Existing Patients 

• Registration Form - patients needing to make changes to their original registration form, i.e. insurance or emergency contact information 
   
• Authorization To Release Healthcare Information – To be used by patients needing to release all or part of their healthcare information to another physician or hospital
   
• Please read our Privacy Policy, then complete this Acknowledgement of Receipt of Privacy Policy