Appointment
Patient Info

Patient Portal

Use our SECURE email communications between GTW and our patients to:

  • Complete patient forms in advance of your visit
  • Request prescription refills (please allow at least 1-3 business days for the refill)
  • Request routine follow-up appointments
  • Send messages about non-urgent medical or billing questions
  • Fees may apply for electronic communication related to medical services

Medical Records Request

These forms can be faxed to 972-733-6564, mailed or dropped off at our office.

New Patient Forms

1) Print and sign the Consent Forms

2) Print and complete the Comprehensive Screening Form

3) Print out and sign the Medical Records request form to obtain a copy of records from your current provider(s) to Girls to Women/Young Men’s Health and Wellness

4) These forms can be faxed to 972-733-6564 or bring them to your first appointment.

Annual Exam Form

1) Print and complete the Comprehensive Screening Form

2) This form can be faxed to 972-733-6564 or bring it to your scheduled appointment.

Sports Physical Form

1) Print and complete the Texas Pre-Participation Physical Evaluation form.

2) This form can be faxed to 972-733-6564 or bring it to your scheduled appointment.

Immunization Signature Sheet

Adult consent is required for immunizations. If your child is under 18 years of age and will be coming to an appointment by themselves, please print, sign and fax the Immunization Signature Sheet to 972-733-6564 prior to their appointment.

©2019 Girls to Women Health & Wellness
16980 Dallas Pkwy 75248 Dallas, United States P: (972) 733-6565
4200 S. Hulen Street, Suite 450, Fort Worth, Texas 76109 P: (817) 524-1811
Fax: (972) 733-6564

Site By: Idealgrowth

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