Patient Forms

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Please select and download the desired form below. After downloading, print and fill out all the information on the form. To view and print these forms you may need Adobe Reader. If you would like to install Adobe Reader on your computer, click here and follow the on-screen installation instructions.

New Patient Information Form

If you are a new patient bring the completed New Patient Information Form with you to your first office visit. This will expedite the time you spend at the doctor's office.

New Patient Information Form

 

Información para Pacientes Nuevos

Transfer of Records Request Form

If you have previously seen a podiatrist and are transferring to Texoma Foot and Ankle Specialists, please complete the Transfer of Records Request form and return it to our office in-person, by fax to 903-463-7711, or by e-mail to texomafootandankle@hotmail.com. We will send the form to your previous podiatrist to obtain your previous records and avoid unnecessary duplication of procedures or treatments.

Transfer of Records Request Form

Patient Records Request Form

In accordance with HIPAA regulations, patients may request copies of their records as needed. We do require 72 hours advance notice to process your request, and a fee of up to $25.00 may be required before documents are released. Please complete the Patient Records Request form and return it to our office in-person, by fax to 903-463-7711, or by e-mail to texomafootandankle@hotmail.com. This form can also be used to request a copy of records to be released to a third party; please designate the recipient in the appropriate area of the form. If you only wish to review your medical chart without obtaining a copy to release, you may do so free of charge by scheduling a time with our office biller.

Patient Records Request Form