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Patient Forms

 

Insurance Accepted

 

AETNA

BLUE CROSS/BLUE SHIELD

CHOICE CARE

HUMANA

HUMANA MOTOROLA

HEALTHSMART - North Texas Healthcare

BCE EMGERGIS PPO

ACCOUNTABLE PPO

CIGNA HMO/PPO

GALAXY PPO

HEALTH PAYORS PPO

PPO NEXT PPO

UNITED HEALTHCARE PPO/HMO/POS/EPO

MEDICARE

CARE N CARE

PRIVATE HEALTH CARE

MULTI PLAN

1. The Notice of Privacy Practices form describes how patient medical information is used and disclosed and how you, the patient, can have access to this information.

 

2. The General Patient Authorization form describes our practice policies and payment policies and procedures. It also outlines policies regarding release of patient information.

 

3. The Minor Consent to Treat form allows the providers in our office to see and treat your child when a parent in not present. All surgical procedures do, however, do require a parent being present.