Adult New Patient
For adults (age 16+) with a new patient appointment
Pediatric New Patient
For children (age less than 16) with a new patient appointment
Receipt and Notice of Privacy Practices (HIPAA)
HIPAA requires all patients to complete this form. Describes how medical information about you may be used and disclosed and how you can access this information.
Red Flags Rule - Information Letter & Payment Processing Form
Information explaining the federally-mandated "Red Flag" rules. Plus, form authorizing MCNT to process a patient's Medical Flex card, personal credit card, or personal check to pay for the services that they receive at the Medical Clinic of North Texas, P.A.
Authorization to Release Medical Information TO MCNT
Form authorizing healthcare provider to release your medical information to Medical Clinic of North Texas, P.A.
Para obtener estos formularios en español, OPRIMA AQUÍ.
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Forms