Regestration Form
New Patient Registration Form
FILL OUT OUR REGISTRATION FORM TO BYPASS THE WAITING ROOM ON THE DAY OF YOUR APPOINTMENT! IF YOU HAVE ANY QUESTIONS, CALL US AT 806-780-4911.
Filling out this form this allows our staff to provide pre-registration as well as shorter waiting times! The information you provide us with will help to create a customized visit that will suit your needs. Your information will always remain confidential.
PLEASE NOTE: Any information in the following form that you elect not to provide must be provided on the date of your appointment. Not providing information before your appointment will increase check-in time as this information will have to be put into our system upon arrival. Our office staff will review your pre-appointment registration information and let you know what we lack when you arrive.
If you have any questions about the form, please don’t hesitate to call us at 806-780-4911.