NEW PATIENT FORMS

Our patient forms are included here for your convenience, and can be viewed using Acrobat Reader. To get it for free, click on the icon below.

View and download patient forms:

• Patient Information Form
• Insurance Information Form
• New Patient Deposit
• Insurance Coverage Guidelines
• Payment Agreeement
• Specific Procedure Waiver
• Insurance Policy
• Payment Policy
• Referral information
• Request for Release of Medical Records
• Notice of Privacy Practices (HIPAA)
• Acknowledgement of Review of Privacy Practices
• Fertility Questionairre (wife)
• Fertility Questionairre (husband)
• Driving Directions: Dallas Office

Contact Information:
Baylor Medical Plaza
Barnett Tower, Suite 502
3600 Gaston Avenue
Dallas, TX 75246
214-823-2692
214-887-8244 (fax)

View location map:
(opens in new window)
Dallas map

For driving directions:
(print friendly PDF)
Dallas Office (124KB)

Contact Numbers:
Surgery Information: ext. 10
Appointments: ext. 11 & 17
Billing Office: ext. 13 & 19
Lab: ext. 15