RHEUMATOLOGY CENTER OF HOUSTON

NEW PATIENT FORMS

-If you need a referral from your primary doctor, please make sure that is available by the date of your appointment.
-If you have had any lab or imaging that may be pertinent, please bring the results, or have your prescribing physician fax the results to 713-640-5872.
-Bring a copy of your driver's license and insurance card to each visit.
-Bring your medication bottles to each visit.

To be filled out:

-Demographics

-Medical History

-Telehealth Consent


To review:

-Office Policies

-Privacy Practices


FOLLOW-UP PATIENT FORMS

To be filled out:

-Patient History Update


To review:

-Office Policies

-Telehealth Policies

-Privacy Practices


MISCELLANEOUS FORMS

-Medical Release

-Telehealth Consent

-Patient Assistance Programs

-New Patient Forms, Printable


1200 Binz St. Ste 1495 Houston TX 77004 US

10907 Memorial Hermann Dr. Ste 300 Pearland TX  77584 US

Office hours:  Monday-Friday 8:00am-4:30pm    

+1.7136405477       Fax +1.7136405872

   

Contacts

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