3310 Live Oak, Suite 210, Dallas, Texas, 75204
877.542.6129 toll-free || 214.821.5400 office
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Patient Forms

We aim to make your experience as convenient as possible. Below, you'll find our easy-to-use downloadable applications. Simply follow the instructions for each respective form.
New Patients
New Patients, welcome! To prepare for your visit, download, complete and print this packet. Included forms: New Patient Form, HIPAA Policy and the Patient Responsibility Form.
New Patient Packet

Existing Patients
Time to update your information? You can do it online! Simply download the form, complete and print it. You can bring it in on your next visit.
Existing Patient Form

Online Payments
Taking care of business just got easier! If you are eligible, you can post payments for your visits right here online. Complete this form to begin the process of payment submission.
Click Here To Pay Online

About Our Forms

HIPPA Policy
The HIPAA Privacy Rule, which protects the privacy of health information, the confidentiality provisions of the Patient Safety Rule and improvement of patient safety can be found here. Download this policy for more complete details.
Patient Responsibility
Health care is a partnership in which the physician and the patient have reciprocal obligations. Learn more about the specific responsibilities of both the physician and the patient, and the process of providing complete healthcare.