Arlington
New Patient Information and Forms
In order to save time filling out forms when you come to your first
appointment we request that all new patients print and read all the
documents and complete the forms listed below. Please bring these
documents and your completed forms to your first appointment. Thank
you.
New Patient No Show Policy
Medical History Form
TPO Consent Form (HIPPA)
Patient Privacy Questionnaire (HIPPA)
New Patient Consent Form
Consent to Use 3rd Party Credit or HSA Card
NEW PATIENTS - Please bring your drivers license or
another form of picture
identification to your first
appointment. We will be making a copy of your identification for your
file.
Dallas
New Patient Information and Forms
New Patient No Show Policy
Medical History Form
TPO Consent Form (HIPPA)
Patient Privacy Questionnaire (HIPPA)
New Patient Consent Form
Wellness Questionnairre
Consent to Use 3rd Party Credit or HSA Card
Waco
New Patient Information and Forms
New Patient No-Show Policy
Medical History Form
TPO Consent Form (HIPPA)
Patient Privacy Questionnaire (HIPPA)
New Patient Consent Form
New Patient No Show Policy (signed)
Concurrent Treatment Disclosure
NEW PATIENTS - Please bring your drivers license or another form of
picture
identification to your first appointment. We will be making
a copy of your identification for your file.
Established Patient Forms
1. Medication Refill Authorization Guidelines
Please print, sign, date and fax along with your completed MRA form
2. Medication Refill Authorization (MRA) Arlington & Dallas Offices
Medication Refill Authorization -(MRA) Waco Office
Please print, complete and fax to our office for processing.
Established Patient No Show Policy - Arlington NEW!
Established Patient No Show Policy - Dallas
Established Patient No Show Policy - Waco
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