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Information for New Patients in Irving & Trophy Club

You will also need to complete our Patient Registration form, Patient Health History forms (Part 1 of 2 and Part 2 of 2), and our Review of Systems form. In order to complete these forms you will need to create an account with our Secure Patient Portal. You’ll find these four forms on the “Health Forms” page within the portal. You can create your secure portal account by clicking on this link.

Additional Patient Forms

Patient information and consent forms are a necessary part of receiving appropriate medical care. In order to save you time at your visit, please feel free to print the consent forms below, and read and sign them before arriving for your appointment. After completing them, you can either bring them with you to the visit, or fax them to us at 214-260-0986.

Click to Print the PDF Forms Below:
Email Regulations patient formFinancial Agreement Physician Assistant Consent for Treatment Authorization to Appeal Insurance Determination

Our medical offices accept the following insurance:

  • Admar Network PPO
  • Aetna HMO
  • Aetna PPO
  • Aetna POS
  • Aetna TRS
  • Affiliated Prov. Systems PPO
  • Beachstreet PPO
  • Blue Choice PPO
  • Baylor Worker’s Comp
  • Blue Cross Blue Shield POS
  • Blue Cross Blue Shield PPO
  • Cigna PPO
  • Cigna HMO
  • Galaxy Healthcare PPO
  • GEHA
  • Greatwest Healthcare PPO
  • Group Resources
  • First Health
  • Health Street
  • Healthsmart Pref. Care PPO
  • Healthsource PPO
  • HMO Blue
  • Humana HMO
  • Humana PPO
  • Medicare
  • NTHC PPO
  • NTHN POS
  • NTHN PPO
  • NTHN EPO
  • One Health Plan PPO
  • Pacificare PPO
  • PHCS EPO
  • PHCS PPO
  • PPO Next PPO
  • PPO Next POS
  • ProAmerica / UHC PPO
  • Secure Horizon Direct
  • Tri-Care Standard
  • Tx True Choice PPO
  • Unicare HMO
  • Unicare PPO
  • United Health Care HMO
  • United Health Care POS
  • United Health Care PPO

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