PATIENT FORMS

If you have questions, call or text 903-957-0275.

NEW PATIENT FORMS
New Patient Forms (link to digital forms)
New Patient Paper Forms  (print and manually fill out if unable to complete the digital form)
Notice of Privacy Practices (HIPAA)

ESTABLISHED PATIENT FORMS
Consent to Treat Minor (digital form)
HIPAA Authorization Form

MEDICAL RECORDS RELEASE
Medical Records Release Form TO us (digital form to request another clinic send records TO us)
Medical Records Release Form FROM us (digital form to send records to another clinic)

Medical Records Release Form (paper form to print and to take another clinic to send records TO us)

HEALTH ASSESSMENTS

These detailed questionnaires help us pinpoint what’s going on. Download and complete the form, then fax it to 903-957-0279 — or just take a picture of each page and text it to 903-957-0275.

GI Health Assessment (print, manually fill out, and text photo to us at the number above)