Dallas Medical Specialists

New Patient Registration

If you are a new patient, you may download and complete the forms below and bring them with you when you come for your appointment.

Patient Registration

Patient Medical History

Patient Financial Responsibility

Medical Information Release Authorization

Other Forms

Satisfaction Survey Email Request

Patient Pharmacy Information

E-Prescription Patient Information

Privacy Notices

This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully

Notice of Privacy Practices

Aviso Sobre Las Practicas De Privacidad

All forms must be completed using BLACK INK only.

These forms require Adobe Reader. If you do not have Adobe Reader, you may download it free here: (this link opens a new browser window).

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