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1125 S. Henderson
Ft Worth, TX
76104
Local
817-870-1056
Fax
817-870-1060

Parking on premise: FREE
Office Hours: By appointment only.
Monday - Friday 8:30 a.m.- 4-:30 p.m.

Click here for Map
Please Click on the forms below to download and Print...
 
Patient Information
 
Personal History Form
 
Patient Consent Form HIPPA
 
Patient Communication Preferences HIPPA
 
Information for my patients
 
As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.
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