Patient Forms

For your convenience, you may download our new patient forms to complete at home prior to coming to our office. Please bring the completed, signed forms with you, along with your prescription medications in the original containers, your insurance card and a picture ID.

New Patient Forms include:

• Patient Information Sheet , which includes basic information about you, including best phone numbers to reach you during business hours, mailing address, other physicians treating you and your insurance information
• Patient Consent Form, which is your consent for us to treat you
• Confidential Communications Request, which directs us to send your treatment related correspondence and communications to an alternate address (for example, if you were staying with a family member during your treatment)
• Permission to Release Information allows us to discuss your treatment, etc. with the people you have listed. For example, this permission would allow us to discuss your care, including things such as appointment confirmations, with a spouse, child, sibling, etc.
• Release of Medical Information to Corpus Christi Cancer Center and Release of Medical Information to Third Party. One of these forms allows us to send medical information about you to other doctors and insurance companies, the other form allows those doctors and companies to send information about you to us.
• The New Patient History gives us a better picture of your health to help us determine the best treatment plan for you.

If you have any questions concerning the forms, please do not hesitate to contact us at 361.985.CARE (2273).