In order to expedite your visit, print, fill out and fax the following forms to (214) 420 – 0397. In addition, copy and fax your Primary and Secondary (if applicable) Insurance card(s) to (214) 420 – 0397 for your insurance to be verified prior to your visit.
If you do not have a fax available, these forms can be filled out in the comfort of your home and brought with you to your visit. Please bring your insurance card(s) with you.
If you do not wish to schedule an appointment telephonically please print, fill out and fax the Appointment Request Form to (214) 420-0397. Our appointment coordinator will be in contact with you within 24 hours to schedule your appointment.
The following forms are to be faxed or brought with you to your appointment to expedite your visit:
Patient Demographic/Patient History Form (English)
Patient Demographic/Patient History Form (Spanish)
Notice of Patient Privacy/Patient Consent Form
Authorization for Treatment