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Patient Forms

Patient Intake Form (English)Patient Intake Form (Espanol)
Medical Records Release Form NEW INCOMING
Medical Records Release Form NEW OUTGOING
HIPAA and PRIVACY NOTICE ACKNOWLEDGEMENT ENGLISH VERSION 2018
HIPAA AND PRIVACY NOTICE ACKNOWLEDGEMENT SPANISH VERSION 2018
PATIENT FINANCIAL AGREEMENT ENGLISH 2018
PATIENT FINANCIAL AGREEMENT SPANISH 2018
Notice of Privacy Practice Comprehensive Version

Fort Worth Main Office

1201 Summit Avenue Fort Worth, Texas 76102
Phone: 817-332-2020
Fax: 817-810-0791

Fort Worth Cityview Office

Southwest Medical Plaza II
5801 Oakbend Trail Suite 100
Fort Worth, Texas 76132
Phone: 817-346-2969
Fax: 817-346-3250

HEB Office

Hurst Town Center Medical Plaza
809 W. Harwood Rd. Suite 304
Hurst, Texas 76054
Phone: 817-788-9303
Fax: 817-514-0752

Granbury Office

HEB Shopping Center
3906 East Highway 377, Suite 103
Granbury, Texas 76049
Phone: 817-579-0100
Fax: 817-279-0699

Weatherford Office

804 Santa Fe Drive
Weatherford, Texas 76086
Phone: 817-594-9500
Fax: 817-596-7081

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