Appointment
Established Patient – Other Forms

FOR SCHEDULED PATIENT VISITS ONLY*  (forms work best on laptop or tablet)

Please complete appropriate forms the SAME DAY as (no sooner than 24 hours before) your scheduled appointment in order to give us the most current information. Depending on the concern or situation, you may need to complete forms from multiple sections.

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.

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FOR OFFICE USE ONLY / BY INSTRUCTION ONLY

COVID-19 Screening Form

New MEDICAL Problems (by PARENT or ADULT PATIENT)

Mood Disorder Questionnaire

Menstrual History (for evaluation of menstrual concerns and/or contraception)

Hormone Consent Form

Headache Assessment (new)

Headache Follow-Up

Asthma Control Test

Nexplanon w/ Benefits Investigation Consent

Mirena/Skyla Benefits Investigation Consent

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P: Dallas: 972-733-6565
P: Fort Worth: 817-524-1811 P: McKinney: 972-502-9099

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