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

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

New Patient 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

Remote Monitoring Consent

HHOA Remote Monitoring Consent

Frequently Asked Questions