(972)-923-8923 141 RVG Pkwy Ste. 101 Waxahachie, TX 75154

Forms

Prior to your initial visit

  •  If you have access to a printer: Please download and print the New Patient Paperwork for completion, and bring to your initial visit.
  • If you do nothave access to a printer: You will be asked to complete New Patient Paperwork upon the arrival of your initial visit.

Upon your arrival

  • 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 you are being seen for a sleep issue, please complete our Sleep Questionnaire.

New Patient Paperwork 

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