Call: (972)-923-8923; Text: (972)-652-0099 141 RVG Pkwy Ste. 101 Waxahachie, TX 75154

Forms

Prior to your initial visit

  •  Please complete the New Patient Google Form and the General Medical History Form prior to your appointment date.
  • ⁠If you are unable to complete the google forms, print the New Patient Paperwork, complete the forms and either email it back to us at general.info@pulmonicsplus.com, fax to 877-399-8499 or bring it in with you to your appointment.
  •  ⁠If you do not have access to a printer then you will be asked to complete the paperwork upon arrival. Please plan on arriving 30 minutes early to allow for completion of these forms.
  • Review the Patient Portal Google Form and either download the Healow App and register for your account or you may register as well using your computer.  The instructions will guide you through the process.
  • Please report to the reception desk
  • We will obtain your most current insurance & identification cards at this time.
  • Copays and/or balances will also be collected during check in.

Established patients

  • It is the responsibility of the patient to notify our office of any and all insurance changes that may occur throughout the year. If the correct insurance is not provided to us, the patient will be responsible for any balances.
  • All payments and balances are due at the time of service. If you have any queries regarding balances, you may contact our billing office to make arrangements.

This packet is required to be completed for all new patients. If the patient is being seen for a sleep issue,  please complete our sleep questionnaire.

New Patient Paperwork 

New Patient Google Form

Patient Portal Google Form

General Medical History Google Form

Sleep Questionnaire Google Form


This form is required if a patient would like to us to release or obtain their medical records to/from another physician or facility.

MR Release 


These forms are to be completed if the patient is being seen for a sleep issue.

Sleep Study Questionnaire 


Please follow the instructions listed on this form. Tracking sleep patterns is an important part of treating our patients for any potential sleep issues.

Sleep Log 


This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

New HIPAA