Please click on the appropriate form(s) below to download or print, fill them out completely, and send them to us via fax (972-542-4106) or email ( Please remember to attach a copy of your driver’s license and insurance card(s), front and back.

Once your information has been reviewed and your insurance verified, a member of our staff will call you to schedule an appointment. If you have any questions, please call our office at 469-742-0199.

Downloadable Forms (PDF)

Adult New Patient Form

Minor New Patient Form

Symptom Checklist

Telehealth Policy

Controlled C2 Medication Policies

Medical Record Request

Release of Medical Information

Medical Letter Request