Phone: 817-260-0535   Fax: 817-984-1448,  Office Hours: M-TH 8:00AM - 5:00PM, F 8:00AM - 12:00PM  
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NEW PATIENT FORMS

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New Patient Forms




To minimize the waiting time on your initial appointment, we have included the new patient registration forms below. Please print and complete each form completely. The last form listed below, Notice of Privacy, is for you to read over and keep for your records. We do not need this form back.

Upon completion, you may bring these forms to the office before your appointment day so that we may enter it into our system, or you can fax it to our office, or bring them with you on the day of your appointment. Whether you choose to fax, drop off, or bring the forms on the day of your appointment, the following items must be accompanied with the forms:  picture ID, copy of the insurance card front & back (can make a copy in the office), and a list of prescription medication you are currently taking.

Click on the form below to download.

- New Patient Registration Package

- Patient Registration Form

- Release of Record Form

- History and Physical Form

- Personal Representative Form

- Authorization Form

- Acknowledgement of Review of Privacy Practices

- Notice of Privacy Form

- No Show Policy Form


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