Patient Forms & Policies
Online Forms

Request an Appointment

Download Forms

Notice of Privacy Practices
Authorization for Release of Records
Cancer Family History Questionnaire
Disclosure Statement for Medical Power of Attorney
Patient Authorization for Use-Disclosure of PHI
Patient Financial and Privacy Policies

Billing & Insurance

Plan Name
Accepting new patients?

Aetna
Yes

Cigna Healthcare
Yes

BlueCross BlueShield
Yes

United Healthcare
Yes

Humana
Yes

Most PPO Plans
Yes

Hospital Affiliations
Baylor All Saints Medical Center in Fort Worth
Texas Health Harris Hospital in Downtown Fort Worth
Texas Health Harris Outpatient Surgery Center
Baylor Surgical Hospital of Fort Worth
Baylor Surgicare

Good Faith Estimate Notice
The federal “No Surprises Act” grants consumers the right to receive a “Good Faith Estimate” explaining how much their medical and mental health care will cost. … Continue reading Patient Information