New Patient

The new patient packet, is an online form containing pages to document your patient history, previous medical information, a privacy notice, a medical release consent form and informed consent forms.

Please pay special attention to your current medications and include dosage and frequency in the medication section.

To ensure you are seen in a timely manner, these forms should be completed prior to your appointment.  Once you have completed filling out the packet on your computer, tablet or smartphone you will submit the forms electronically. You will have the option to save a copy for your records.

As a first-time patient, please show up twenty minutes early to your appointment.

Enter your name and date of birth. Then check all the appropriate boxes. Choose Files to select the document, then press Form Attachment to upload the document. You may remove the file by pressing X next to the file.

You may upload up to ten files. (.jpg,.png,.bmp,.tif,.pdf)

• Patients must wear a mask while in the clinic.
• We are a touch-less clinic, all documents, forms, and payments are taken online.
• Only the patient is allowed in the exam room other participants will participate remotely on or off site.
• The patient will be asked to remain in their vehicle until their visit begins in-person.
• All individuals entering the clinic must complete a COVID-19 screener and have their temperature taken.

Coronavirus disease 2019 (COVID-19) and you.

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Medical Release Form – Records needed for continuing care purposes will be sent directly to the physician we refer you to upon their request.

For all other providers, our office requires a signed Medical Release Form.

Requests for medical records for reasons other than continuing care require a $25 Medical Request Fee paid in advance of your request.

EMG Referral Form – A number of disorders are better identified and more effectively diagnosed using Electromyography and Nerve Conduction Studies in conjunction with Magnetic Resonance Imaging (MRI). Please consider referring your patients for EMG/NCS testing to help you deliver an accurate diagnosis in confidence. Our Board Certified Neurologist is fellowship trained in neurophysiology.

FMLA/Disability Form – Please complete the request form and make the appropriate payment. Payment is required prior to starting your request. Any information that should be included must be in this form. Any change in language or addendum will require a new form and fee. 

We are continuously adding new insurance carriers to our list. If your insurance provider is not listed here please call us at (214) 494-4424 ext 2 to speak with one of our staff members about your particular insurance type.

• Ambetter Exchange Plan
• Ambetter Medicaid
• Aetna QHP
• Medicaid
• Molina Medicaid
• Optum Health
• Oscar
• Texas Health Aetna

Notice of Privacy