For your convenience, we have included the patient forms that need to be read and/or completed at the time of your first visit.
Please print the forms, fill them in and bring the completed forms with you to your first visit, or you may complete and fax them to us at (210) 653-7014.
- Patient Registration/Consent for care and treatment— complete this form
- Authorization for the Release of PHI— complete this form
- Patient HIPAA Acknowledgment & Disclosure Consent (printable) — complete this form
- Patient Financial Agreement — complete this form
- Health History — complete this form
- Breast Screening Assessment — complete this form only if you will be seen for a breast condition
Formas en Español
- Consentimiento General de Atención y de Tratamiento— complete este formulario
- Autorización para Divulgación de PHI— complete este formulario
- HIPAA Consentimiento— complete este formulario
- Acuerdo Financiero del Paciente - complete este formulario
- Antecedentes Médicos - complete este formulario
- Evaluación del Examen de los Senos - complete este formulario
If you should have questions regarding the completion of these forms, please don’t hesitate to call our office at (210) 653-9307 for assistance.