New Patient Form

In order to guarantee the success of your initial appointment we require that you complete the following form in its entirety. If you have any questions about anything on the form please call our office for help PRIOR to your appointment. Without a completed form you will not be seen by the doctor at our Dallas office. You will need to fill out this form whether you are seeking pain management or psychiatry interventions.
Be prepared to pay your copay and any insurance deductibles at the time of visit. If you are unable to pay at sign in you will not be seen and will be rescheduled. We accept credit cards and cash as methods of payment.

Please also bring your ID and insurance card to your appointment.

If you need to cancel please do so before the 24 hours leading to your appointment. A cancellation within the 24 hour window will be seen as a “no show” and you will be subject to a $400 rescheduling fee.