NEW PATIENTS

NEW PATIENTS FORMS
In order to serve you better and faster we have provided our New Patient Information Form online.

Click on the links below to access the New Patient Form. After you click the link, a browser window will open. After it opens, click on the 'PRINT' icon on your browser. After the form prints, fill it out and bring them into our office. Completing the New Patient Information Form will save you time on your initial visit!

» New Patient Information Form » New Patient Information Form (SPANISH)
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INSURANCE
Aetna US Health Care
Beech Street
Blue Cross & Blue Shield (includes Federal Plans)
Choice One
Community Health Electronic Clearing House
Employee Benefit Administrators
Ethix Southwest
Galaxy Health Network
Health Smart
Humana
Lifere
Medicaid
Medicare
New Horizon Administrators, Inc.
Newton Healthcare
Nylcare
Preferred Health Arrangement
Principal
Prudential Healthcare
Railroad Medicare
Southwest Preferred Network
TML (Texas Municipal League)
Texas Chip Program
Texas True Choice
USA Managed Care Organizations
USC Health Choices
Unicare
United Healthcare
United Payors & United Providers Managed Care, Inc.
Valley Care Choices

NO INSURANCE? NO PROBLEM!
Allow us to introduce Care Credit. Care Credit is a credit card given to patients to help pay for medical expenses without having to worry about not being able to meet a co-pay/deductible, or even for patients who have no type of insurance coverage. This method of payment allows you to see the physician for medical care, pay your medical expense, and in turn allow you to pay the designated bank a low monthly payment which can range as low as $10 - $12 per moth, depending on the amount owed. Please keep in mind this method of payment is not accepted by all providers in the medical field. For further information, please contact our office at 956-618-2970, ask for Erica.