Patient Forms

Patient FormsIt can be difficult trying to remember medical history, insurance information, medications and all of the other information that we will need in order to have a complete medical history on file for you. Because of that, you might find it easier to fill out the new patient paperwork before your first visit.

For your convenience, these forms are downloadable, or we would be happy to mail, email or fax them to you, if you prefer. Just call us at 817-732-6060.

Along with the completed forms, please bring the following:

  • Photo ID
  • Insurance Card
  • Medication Bottles

New Patient Forms collect the following information:

  • Patient contact information
  • Insurance information
  • Patient’s Other Health Care Providers
  • Personal Medical History
  • Family Medical History
  • Medications
  • Allergies
  • Hospitalizations
  • Surgical History
  • Social History
  • Depression Screening
  • Alcohol and Drug History
  • Tests and Health Screenings

In addition, you will need to sign a Medical Records Release-General Consent Form so that we may treat you.

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