New Patient Appointment

New Patient Forms and Info

Thank you for choosing our office. For your convenience we have provided the following forms for you to download and complete prior to your appointment . Please fill them out and bring them with you to your appointment.

Download New Patient Download Billing Download Patient Agreement Download Privacy Form

New Patient Scheduling Request

To speed up scheduling and insurance verification please fill out as much of the following information on the form below as possible. If you are not comfortable providing some of the information please fill out as much as you can and a member of our office staff will contact you by phone to help complete the required information.

Please have your insurance card available when you are contacted to schedule your appointment.

Your Name(Required)

Address(Required)

Your Email(Required)

Patient's Date of Birth(Required)

Patients Sex(Required)

Employer or N/A

Insurance Company or write " self pay "

Mental Health or Behavioral Health Carrier Check on the back of insurance card

Policy or ID Number

Group Number

Policy Holder's Name ( Please complete only if the Insurance is carried by someone other than the patient )

Policy Holder's Employer ( Please complete only if the Insurance is carried by someone other than the patient )

Policy Holder's Date of Birth ( Please complete only if the Insurance is carried by someone other than the patient )

Additional information or comments

Please Note: Appointments are not confirmed until you receive a reply from the office

What to Bring to Your Appointment

Insurance Card
List of current medications
Completed new patient packet ( see above )
Please arrive 20 minutes prior to your appointment time so that we may complete your initial paperwork and verify your insurance information

Cancellations

If you are unable to keep your appointment please call 281.277.9137 to cancel or reschedule at least 24 hours in advance. This allows us to use the time slot for another patient that may be waiting for an appointment. Please note that there is a $50 charge for appointments not cancelled 24 hours ahead of time. We understand emergencies or certain unavoidable circumstances can occur and we will be happy to work with you if such things come up.

Call Us

Fax