We ask that new and established patients complete or update their patient registration annually. Patients can complete this process by either logging into the secure patient portal or downloading the following forms. Click on the title of each form below to download them.
- Patient Forms
- Only Medicare Patients Screening Form
- Authorization to Treat a Minor Form
- HIPAA Disclosure
- Accepted Insurance List
- Grapevine Area Map
- Keller Area Map
All patients should complete 1. Patient Forms. In addition, Medicare patients should also complete 2. "Only Medicare Patients Screening Form" - a Medicare screening for Coordination of Benefits. Anyone under 18 should have their guardian complete 3. "Authorization to Treat a Minor."
You can access your patient portal to efficiently fill out all of the necessary forms. The requested forms should then be submitted to our office when you arrive about 15 minutes early to your appointment. Your forms may also be submitted via our secure fax 48 hours prior to your appointment at 817-886-3612. This will help us update your record and expedite your visit.
Please call our office if you have any questions regarding the a secure portal login or if need the Spanish version of these forms at 817-416-6155.