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Patient Forms

Please take a minute to print and fill out the patient information form before your first appointment:

Please fill out each form individually

  • Health History Form
  • Acknowledgement of Receipt of Privacy Practices
  • Risks and Limitations
  • Pediatric Sleep Questionnaire
  • Social Media Use and Disclosure
  • Notice of Privacy Practices (PDF)
  • Notice of Electronic Disclosure (PDF)
  • Autodraft Authorization Form

If you’re unable to open PDF files, you can get Adobe Reader for free.

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Mount Pleasant

2015 W Ferguson Rd
Mt Pleasant, TX 75455

903-572-8543

Sulphur Springs

425 Industrial Dr. East
Sulphur Springs, TX 75482

903-572-8543

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