Patient Forms / Financial Information
Upon check-in, the following will be requested:
- Copy of current insurance card & driver's license.
- Current demographic information.
- Co-pay, co-insurance, & visit fees will be collected at time of service.
- If a current insurance card is not provided, the patient will be considered self-pay. Self-pay patients will be financially responsible for the entire balance at time of service.
- Out-of-network patients will be billed accordingly & balance collected at time of service.
Our doctors try to stay on schedule. Unfortunately, unforeseen emergencies do arise. We ask for your patience when these delays occur.
We recommend you print and fill out these forms prior to your appointment to save you waiting time.
Note: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here.
- Texas Health Plano Hospital
- Texas Health Frisco
- daVinci Surgical
- The American College of Obstetricians and Gynecologists
- Medical City Dallas Hospital
- Texas Health Resources
- American Cancer Society
- National Women's Health Resource
- The North American Menopause Society
- U.S. Department of Health & Human Services - WomensHealth.gov