Forms - New Patient - Release of Information - Eligibility
New Patient Forms
If you are a new patient, you will need to complete the form below before seeing a health care provider. Print and fill out the New Patient Form in the comfort of your home and avoid having to come 30 minutes earlier for your appointment to do paperwork.
Endocrinology Referral Form
Click to Complete this Form and Print or Save
An eligibility appointment is very important in order to assess whether or not you qualify for various programs and/or financial aid from the government. Our Eligibility Specialists are highly-trained and will match you with the best options you have so that you will benefit from the most affordable health care solution.
Eligibility Requirements (English)
Eligibility Requirements (Spanish)
New Patient Information Package
Release of Information (ROI) Authorization
Please click here for details and forms
Birth Control – Parent/Guardian and Minor Consent Forms
Due to a recent federal court ruling in Deanda v Becerra, Cause No 2:20-CV-092-Z, in the United States District Court for the Northern District of Texas, Amarillo Division, EFFECTIVE IMMEDIATELY, we are no longer able to provide birth control services to patients under the age of 18 without the consent of a parent/guardian. This includes all minor patients regardless of payor source.
Parent / Guardian Consent Form (English)
Parent / Guardian Consent Form (Spanish)