Forms

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:

• New Patient/Change in Demographics
• New Patient Medical History
• Telehealth Consent
• Office Financial Policies
• Feedback Form
• New Patient Forms, Printable (if not able to fill out online)

To review:

• Office Policies
• Privacy Practices

MISCELLANEOUS FORMS

• Medical Release
• Telehealth Consent
• COVID-19 Informed Consent To Treat
• Patient Communication Consent