Forms

 Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. 

Click on the above photo to download the Medical Records Request form, this form is used to request medical records to be send to us or for us to send medical records to an outside facility.  Note that we use a third party to do medical records for us.  Once you fill this out, sign it, and fax it to us (or to the doctor you are trying to have send records sent to us) at 972-981-3600. 

Welcome!  Please download and fill out this form, then bring it with you or fax it to 972-981-3600 along with a copy of your diver's license and both sides of your insurance card. 

 The HIPAA Privacy Rule requires health plans and covered health care providers to develop and distribute a notice that provides a clear, user friendly explanation of individuals rights with respect to their personal health information and the privacy practices of health plans and health care providers.   Click on the photo above to read our HIPAA notice.