Patient forms

NEW PATIENT FORMS

Prior to your 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.

• Patient Information

  • 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.

• Texas Immunization Registry

  • Para completar el formulario en español, haga clic aquí.

  • Available in English and Spanish

ESTABLISHED PATIENT FORMS

COMMERCIAL PATIENTS (NON-MEDICARE):

• Cancer Family History Questionnaire

• Medication List

MEDICARE & MEDICARE ADVANTAGE PLAN PATIENTS:

• Cancer Family History Questionnaire

• Medication List

ADDITIONAL GENERAL FORMS:

If you are an established patient with anxiety, depression or ADD, you will be asked to fill out related questionnaires. You are welcome to streamline the process by clicking the linked documents below and completing the forms ahead of time.

• Anxiety (GAD7)

  Depression (PHQ9)

• Attention Deficit Disorder (ADD Self Report)

• Controlled Substances:

  • Controlled Substance Contract

  • Opioid Risk Tool

  • COMM (Current Opiod Misuse Measure)