New Patient Forms
Welcome to our practice! We look forward to meeting you.
Below is the form that we ask you to complete. Click on the link. Please follow the prompts. Each section must be filled out accordingly and submitted. At the end of the registration you will receive a confirmation number.
Patient Education Forms
Insurance and Billing Information
We accept most Commercial Insurance Plans and Medicare.
However, we do NOT accept following insurance plans.
- Any Medicaid HMOs
- North Texas Physicians
- Cigna Focus Flex Silver
- AM Better
- Aetna Medicare Replacement (We accept all other Aetna plans)
If you have a question regarding your plan, please call our office 972-899-2170 or email us email@example.com
We strive to provide quality care and service to patients. Co-pays and balance are due when you check in for your appointment and prior to receiving treatment or surgery. To make your visit more convenient we currently accept the following payment methods:
- Personal Check
- Debit cards
- Credit cards – Visa, Master, American Express, Discovery
If you have questions regarding your bill, please call the Billing Department at 972-899-2170 or email firstname.lastname@example.org