Patient Forms
Help us expedite your check-in process by faxing your completed forms to 512-458-7879.
Online Appointment Form
Online form for new Patients.
New Patient Forms/Packet English | Spanish
New Patient Forms/Packet Dallas/Ft. Worth Area
All forms required for a new patient in a single download.
Registration Form English | Spanish
Printable New Patient Form
Patient Financial Policy English | Spanish
This document explains Texas Cardiac Arrhythmia’s financial policy.
Confidential Health History English | Spanish
The confidential health history form supplies essential information that can assist with diagnosis and treatment decisions. The information in this form also helps to determine an individual’s baseline, or what is normal for that individual.
Authorization For Release Of Medical Records English | Spanish
This form provides authorization for the release of your medical records.
Notice Of Privacy Practices English | Spanish
HIPAA is a US Federal Government legislation known as the Health Insurance Portability and Accountability Act. This legislation concerns your rights as a consumer of health care privacy practices. It affects not only how your personal medical information is handled but how you and your confidential information are treated when working with your doctor, health insurance provider or other medical practitioner. This is all done to protect you.
Patient HIPAA Form English | Spanish | Arabic | Simplified_Chinese
Printable New Patient Form
Consent For Care And Treatment Form English | Spanish
Printable New Patient Form
Medicare As Secondary Payer Patient Form Requirement English | Spanish
Printable New Patient Form
Patient Rights English | Spanish
Printable New Patient Form
Patient Consent For Financial Communications English | Spanish
Printable New Patient Form