Helpful Information for New Patients

New Patient Forms

Personal information form

General information to help us identify you and your records. Please print and complete this form prior to your appointment. Please be as accurate as possible to optimize your treatment.

Medical History

To provide the best care, help us understand your prior medical history. Please print and complete this form prior to your appointment. Please be as accurate as possible to optimize your treatment.

Assignment of Benefits

Please print and complete this form prior to your appointment. Please be as accurate as possible to optimize your treatment.

Privacy Notice Acknowledgement

Use this form to verify that you received the required privacy notice. If you have not received the privacy notice yet, you can wait and sign this at the time of your appointment.

NOTE: If you do not have Acrobat Reader you can get one for free by clicking on the icon. This will take you to Adobe’s website and enable you to download the Acrobat program to your computer.

Insurance Accepted

We work with most medical insurance providers, including commercial insurances, Medicare, and Medicaid. We encourage all patients to check with their health insurance plan to verify their benefits. If you would like us to assist you with insurance verification, please let us know. We also accept patients who do not have health insurance.

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1948 E. Hebron Pkwy #200, Carrollton, TX 75007 972.395.7131