Online Forms Click the form you need below. Accept the security certificate by clicking "Yes" or "OK" on the security information window. Once the form is visible on your computer monitor, fill it out. Complete all sections of the form. It is absolutely vital to have the information requested for proper billing and claims submission. Your assistance and cooperation with this request is extremely helpful and appreciated. Finally, click the SUBMIT button and it will be electronically sent to the clinic of your choice! Patient Information

Fax Forms
Choose the form you need below. Once the form is visible on your computer monitor, print it out. Complete all sections of the form. It is absolutely vital to have the information requested for proper billing and claims submission, especially on the Patient Information form. Your assistance and cooperation with this request is extremely helpful and appreciated. Finally, you can bring these forms with you to your next visit or fax them. For your convenience, we've even included fax cover sheets for each location! (You will need the free Adobe Acrobat Reader to view these forms.)
Patient Information	Insurance Change/Update
Billing Questions Fax to number on form only	Appointment Request Arlington clinics only Fax to the clinic's main fax number, found here.
Medical Records Release

Fax Cover Sheets Allen Office Arlington - Fielder Road Office Arlington - SW Green Oaks Office Arlington - Randol Mill Office Colleyville Office North Dallas Office (RHD Hospital) North Richland Hills Office Garland - Broadway Office Garland - Beltline Office (Medical Plaza) Grapevine Office

* Other time saving suggestions:

• We must maintain a copy of your insurance card in your medical chart. If you have access to a copier, please bring a copy of both sides of your card with you to your next appointment. You may fax it with the completed Patient Information form.
• A patient information form must be completed for each member of the family and a copy of their insurance card kept in their chart.
• If any of the information requested on our registration form has changed, an updated form will help us to better serve you.