Patient Forms
Please print and complete the following forms before your first visit to save time at check-in.
New Patient Packet
Complete registration, medical history, welcome letter, PHQ-9/GAD-7 screening, and Vitamin B12 questionnaire.
7 pages· Print-ready
Consent to Treat
Consent for medical treatment, billing and services rendered, and acknowledgment of privacy practices.
1 page· Print-ready
HIPAA Authorization
Authorization to disclose protected health information per Texas Health & Safety Code.
1 page· Print-ready
Medical Records Release
Request to release medical records to Legacy Partners for Equitable Healthcare.
1 page· Print-ready