Patient Forms

Help us expedite your check-in process by faxing your completed forms to 512-617-2991.

Online Appointment Form

Online form for new Patients.

New Patient Forms/Packet[0units_b]

New Patient Forms/Packet Spanish[2units_m]

All forms required for a new patient in a single download.

New Patient Form [71units_k]

New Patient Form Spanish [101units_k]

Printable New Patient Form

Patient Financial Policy [86units_k]

Patient Financial Policy Spanish [89units_k]

This document explains Texas Cardiac Arrhythmia’s financial policy.

Confidential Health History [99units_k]

Confidential Health History Spanish[258units_k]

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 [66units_k]

Authorization for Release of Medical Records Spanish[29units_k]

This form provides authorization for the release of your medical records.

Notice of Privacy Practices [414units_k]

Notice of Privacy Practices Spanish[566units_k]

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[56units_k]

Patient HIPAA Spanish[352units_k]

Patient HIPAA Arabic [120units_k]

Patient HIPAA Simplified_Chinese.[195units_k]

Printable New Patient Form

Consent for Care and Treatment form[11units_k]

Consent for Care and Treatment form Spanish[85units_k]

Printable New Patient Form

Medicare as Secondary Payer Patient Form Requirement[28units_k]

Medicare as Secondary Payer Patient Form Requirement Spanish[31units_k]

Printable New Patient Form

Patient Rights[214units_k]

Patient Rights Spanish[212units_k]

Printable New Patient Form

Patient Consent for Financial Communications[104units_k]

Patient Consent for Financial Communications Spanish[113units_k]

Printable New Patient Form

Frequently Asked Questions[628units_k]

Meet Our Physicians

Meet Our Physicians

Learn About Heart Rhythm Disorders

Learn About Heart Rhythm Disorders

Review Our Procedures

Review Our Procedures

Meet Dr. Andrea Natale

Meet Dr. Andrea Natale

Our Latest News

Our Latest News