Appointment
Patient Info

Patient Portal

Use our SECURE email communications between GTW/YM 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

New Patient Forms

Please be advised that by providing this form for you to contact our office(s), we are not confirming an appointment nor establishing a physician-patient relationship. As a user of this mode of communication and of our website, you assume all risks with placing confidential information into this portal. Our office will follow up with you within 24 to 48 business hours.  Please note: We may not see submitted forms for 24 hours depending on when the forms were completed.  For any safety concerns, thoughts of self-harm or suicide, or severe medical symptoms please call 911 for medical emergencies or text “help” to 741-741 or call the National Suicide Hotline at 1-800-273-8255, https://suicidepreventionlifeline.org/

*Not intended for use by the general public but only for patients with scheduled appointments.

1) Complete and sign the Consent Forms

2) Complete the Comprehensive Screening Forms

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 completed online and/or faxed to 972-733-6564 or bring t

1) Complete and sign the Consent Forms

2) Complete the Comprehensive Screening Forms

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 completed online and/or faxed to 972-733-6564 or bring them to your first 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.

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.

©2019 Girls to Women/Young Men's Health & Wellness
P: Dallas: 972-733-6565
P: Fort Worth: 817-524-1811 P: McKinney: 972-502-9099

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