patient information
new patient forms
New patients requesting to establish care with us — for the first appointment, you will be asked to fill out the forms listed below. You may fill them out at our office or print and complete them at home and bring them into our office at the time of your appointment.
When you fill out this form, you will be asked to verify that you have read the Notice of Privacy Practices, which can be found here
Para completar el formulario en español, haga clic aquí
Available in English and Spanish
established patient forms
If you are an established patient with us, you will be asked to fill out paperwork at every one of your Annual Wellness Visits. You are welcome to streamline the process and complete the forms ahead of time.
COMMERCIAL PATIENTS (NON-MEDICARE):
Commercial Wellness Checkup- click link to complete form: https://hipaa.jotform.com/adultcareaustin/comm-wellness
MEDICARE & MEDICARE ADVANTAGE PLAN PATIENTS:
Medicare Wellness Checkup- click link to complete the form: https://hipaa.jotform.com/adultcareaustin/mwv
ADDITIONAL GENERAL FORMS:
Anxiety (GAD7): https://hipaa.jotform.com/adultcareaustin/gad-7
Depression (PHQ9): https://hipaa.jotform.com/adultcareaustin/phq-9
Attention Deficit Disorder (ADD Self Report): https://hipaa.jotform.com/adultcareaustin/adhd-screener
Controlled Substances:
Controlled Substance Contract: https://hipaa.jotform.com/adultcareaustin/controlled-substances-agreement
Opioid Risk Tool: https://hipaa.jotform.com/adultcareaustin/opioid-risk-tool
COMM: https://hipaa.jotform.com/adultcareaustin/comm
insurance plans
The following are lists of insurance plans we do and do not accept at Adult Care of Austin. While we strive to stay "real-time," the list is not inclusive and may well include some inaccuracies because insurance networks and companies change and merge constantly. We have found it impossible to keep our list completely accurate. This list and the corresponding links are provided for your convenience.
Many plans allow out-of-network benefits, so when you call our office to make an appointment with one of our physicians, we assume you've made an informed decision. We do not verify participating status in our patients' insurance plans. We desire to provide care to anyone who wishes to consult one of our physicians, with very few exceptions. (See the list at the bottom of this section for a list of insurance plans we have chosen not to accept.)
COMMERCIAL PLANS WE ACCEPT:
Aetna incorrectly lists Dr. Dobberfuhl as participating in all plans; we do not accept any HMO plans that require authorizations for referrals.
If you search under Dr. Dobberfuhl’s name, nothing will come up; however, if you search under “Primary Care Providers” in the 78745 zip code, he will show up.
HealthSmart ACCEL only
This is individual policy sold through the Affordable Care Act Market
UnitedHealthcare (Commercial Insurance only)
MEDICARE AND MEDICARE ADVANTAGE PLANS WE ACCEPT:
Traditional Medicare Part B
BCBS Medicare Advantage PPO (NOT HMO IN 2024)
We continue to care for our established patients who are Texas RETIRED TEACHERS and State of Texas EMPLOYEES with whatever insurance TRS and ERS choose.
PLANS WE DO NOT ACCEPT AT THIS TIME:
Any HMO plan INCLUDING BCBC Medicare Advantage HMO
NO LONGER ACCEPTING IN 2024
Medicaid
Amerigroup
WellMed
Workers’ Compensation
Third-party insurers (automobile or homeowners)
Market (FirstCare, BCBSTX Market, Ambetter, Molina)
WE ARE NO LONGER ACCEPTING:
Humana Gold Plus (HMO) H00028-037
HumanaChoice (PPO) H0473-001
HumanaChoice (PPO) H5216-128
HumanaChoice Regional (PPO) R4182-004
HumanaChoice Austin (LPPO) H0473-003
WellCare Texan Plus Classic HMO H0174002000
WellCare Prime (PPO) H7323-001-000
Aetna Medicare Premier Plan (HMO) H4523-001
Aetna Medicare Plus Plan (PPO) H3288-022
Aetna Medicare Choice Plan (PPO) H3288-004