North Texas Foot & Ankle

Patient History Form

Insurance Information
 

 

 

 

 

 

5510 Abrams, Suite 103        2020 N. Glenbrook Drive

Dallas, Texas 75214              Garland, Texas  75040

( 214) 369-3969                       (972) 530-3000

 

 

In order to serve you better and faster we have provided our new patient forms online. You can complete the information online then print each form and return them to our office.

Option 1: Complete the New Patient Process Online
This option allows you to complete the new patient process online then print the completed form. Please complete patient history form and insurance form.

Instructions:
Step 1: Click on the link to access the new patient form. Once it opens, complete all the information on it then click on the 'PRINT' icon on your browser or "File" then "Print".

Step 2: Click on the link to access the health history form. Once it opens, complete all the information on it then click on the 'PRINT' icon on your browser or "File" then "Print".


Option 2: Printable Form
If you have a printer, you can print out our new patient form and our medical history form. After printed, bring the completed forms to our office on your initial visit.

Instructions:
Step 1: Click on the link to access the new patient form. Once it opens click on the 'PRINT' icon on your browser or "File" then "Print".

Step 2: Click on the link to access the health history form. Once it opens, complete all the information on it then click on the 'PRINT' icon on your browser or "File" then "Print".

Step 3: At your convenience, complete all the information on each form. Please provide both completed forms when you arrive at our office. Completing the new patient form will save you time on your initial visit!


Foot care for the whole family


Specializing in Pediatrics


Sports Medicine