Appointment Request

Appointment Request Form:

If you would like to request an appointment, please fill out the online appointment form and click the "Send" button. You will be contacted by our office manager within the next 24 hours to confirm your appointment and/or reschedule your appointment in case of a scheduling conflict. You may also make an appointment by telephone or fax. Our phone number is 214.528.1900 and our fax number is 214.528.1917.

Name:

Doctor's Name (Leave Blank If Unknown):

Date:

Time:

E-mail:

Phone:

Health History Form:

There is no need to fill out an online history form. You will be asked to fill out a brief welcome sheet when you arrive at the clinic.

PDF of the Health History Form

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