NEW PATIENT FORMS
For your convenience, you may print and complete the below forms prior to your first visit. Please scan and send to firstname.lastname@example.org or FAX to (713) 790 – 0254. You may also include a copy of your insurance card as well as your driver’s license and medical prescription to expedite the verification process.
PLEASE CALL US TO VERIFY BENEFITS!
WE ACCEPT MOST PLANS FROM THE COMMERCIAL COMPANIES LISTED.
PLEASE CONTACT US DIRECTLY IF YOU DO NOT SEE YOUR HEALTH PLAN BELOW.
Blue Cross Blue Shield
Medicare Part B
TriWest (Veteran's Affairs)