Office Forms
Download and complete your forms before your visit to save time at check-in.
To help us serve you better, please review and complete the forms below prior to your appointment. If you are unable to print them, copies can be provided at your first office visit, *allow for 30 minutes to complete
New Patient Registration
Complete this form before your first visit. Includes personal information, emergency contacts, and insurance details.
Medical History Questionnaire
A comprehensive health history form covering past diagnoses, surgeries, social history and family history.
Medications & Allergies
List your current medications, dosages, and known allergies so our team can review them at your first visit.
Vaccine History
Please contact your Pharmacy or Physician(s) to document your last vaccination for each type of vaccine listed.
HIPAA Authorization & Consent
Authorization for the use and disclosure of your protected health information as required by federal law.
EPC / Membership Agreement
Review and sign your Direct Primary Care (DPC) membership agreement outlining services, fees, and terms.
ACH Payment Authorization
Authorize automatic bank account (ACH) payments for your monthly DPC membership fee.
Ordering Genetic Testing from Sequencing.com
Instructions and recommendations for ordering genetic testing through Sequencing.com
Optional: Texas "Do Not Resuscitate" (DNR) Form
Official Texas Out-of-Hospital DNR form. Complete with your provider if you wish to document your end-of-life resuscitation preferences.
Optional: Advance Directives
Document your healthcare wishes and designate a medical power of attorney to guide your care if you are unable to speak for yourself.
Optional: Medical Power of Attorney
Designate a trusted person to make healthcare decisions on your behalf if you become unable to communicate your wishes.
Need help with a form?
Our team is happy to assist. Call us at (210) 722-0527 or email [email protected] and we'll walk you through the process.
Ready to become a patient? Learn about our new patient process