"Erin is superbly kind hearted. She is a true jewel in her field."

Alexa | Plano, Texas



First Visit Forms

To support our Green Office Policy, we are working hard to minimize the paper forms that we use. If you have an email address, please contact our office at (972) 991-8870 and request our ePatient Welcome Packet. This packet can be completed online, signed electronically and submitted to our office without the need to print anything. You'll also receive a copy of the electronically signed documents for your records.

If you do not have email, you can download our Welcome Packet in pdf format so that you can print the forms and complete them and then bring them with you to your appointment. The welcome packet includes:

  • New Patient Information - provides detailed information regarding your insurance and employment information.

  • Our Office Policy - This policy is new and effective 03/01/15 and outlines our office policies and procedures for our practice and requires a signature on the bottom of the form.

  • Authorization of Use and Disclosure of Protected Health Information - if you wish for anyone other than yourself and your primary obstetrician to have access to your private health information you will need to fill out this document. If you do not wish for anyone outside of yourself and your doctor to have access to your information, then you will not fill out this form.

  • Notice of Privacy Practices - this is for your records only. We have copies of this notice in our office. We will ask you to sign the Acknowledgement of Receipt of Notice of Privacy Practices

    Click this link to Download your Welcome Pack

To protect the confidentiality of your personal information provided on the above forms, we use SSL technology (https) to encrypt your information before transmitting from your PC to our server.

 

 

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