Adult New Patient
For adults (age 18+) with a new patient appointment

Pediatric New Patient
For children (none less that 5 years old) with a new patient appointment

Notice of Privacy Practice
Describes how medical information about you may be used and disclosed and how you can access this information.

Receipt of Notice of Privacy Practices
HIPAA requires all patients to complete this form.

Medical Release
Form authorizing healthcare provider to release your medical information to Medical Clinic of North Texas, P.A.

Medical Information Release
Authorizes Medical Clinic of North Texas, P.A. to release your medical information to specific entities.

Frequently Asked Questions
HIPAA as it relates to our patients.

Request for Correction / Amendment to Record
Allows you to request a correction / amendment to your medical record.

Know Your Benefits
This pamphlet can assist you in learning about your insurance benefits, including questions to ask your provider.

Financial Policy
Explains payment of services

Amy Bredenberg, M.D. is Board Certified by the
American Board of Family Medicine

2253 Central Dr.
Bedford, TX 76021
(817) 868-9202

6984 Rufe Snow Dr.
Fort Worth, TX 76148
(817) 427-9353

Family & Sports Medicine
Board Certified by the
American Board of Family Medicine

Dr. Bindner also hold a Certificate
of Additional Qualification by the American Board of Family Medicine
in Sports Medicine

Internal Medicine & Pediatrics
Board Certified by the
American Board of Internal Medicine

Dr. Olivo is also Board Certified
by the American Board of Pediatrics

Family Medicine
Board Certified by the
American Board of
Family Medicine

Internal Medicine & Pediatrics
Board Certified by the
American Board of Internal Medicine

Dr. Walker is also Board Certified
by the American Board of Pediatrics