Adult New Patient
For adults (age 18+) with a new patient appointment
Full Packet | Required Pages Only
Formato Completos | Formato Requeridos

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.
Recepción y Aviso de Prácticas de Privacidad
Describe cómo la información médica sobre usted puede ser usada y revelada, y tambien cómo usted puede tener acceso a esta información. HIPAA exige que todos los pacientes completen este formulario.

Medical Release
Form authorizing healthcare provider to release your medical information to Medical Clinic of North Texas, P.A.
Autorización para Divulgar
Información Médica a MCNT
Esta forma provee autorizacion de divulgar su información médica a Medical Clinic of North Texas, P.A.

Financial Policy
Explains payment of services
Póliza Financiera
La póliza sobre pago

Authorization to Release Medical Information FROM MCNT
Authorizes Medical Clinic of North Texas, P.A. to release your medical information to specific entities.
Autorización para Divulgar Información Médica de MCNT
Autoriza a Medical Clinic of North Texas, P.A. a divulgar su información médica a entidades específicadas.

HIPAA Patient Education - Frequently Asked Questions
HIPAA as it relates to our patients.
Educación al Paciente de HIPAA – Las Preguntas más Frecuentes
Preguntas de nuestros pacientes.

Request for Correction / Amendment to Record
Allows you to request a correction / amendment to your medical record.
Petición de Corrección / Modificación de Registro
Le permite solicitar una corrección o modificar su expediente médico.

Know Your Benefits
This pamphlet can assist you in learning about your insurance benefits, including questions to ask your provider.
Conozca sus Beneficios
Este folleto le puede ayudar a aprender acerca de sus beneficios de seguro, y preguntas que puede tener para su proveedor.

Claudio S. Lehmann, M.D.

San Juan de Dios Hospital
Santiago, Chile

Dallas V.A. Hospital
Dallas, Texas

Dr. Lehmann lives in Fort Worth with his family.

CONGRATULATIONS to Dr. Lehmann who was recognized as a TOP DOCTOR in the April 2010 edition of Fort Worth, Texas Magazine.

Dr. Lehmann was recognized as a Top Doctor in the 2009 edition of Fort Worth, Texas Magazine.

6205 Westcreek Dr.
Fort Worth, TX 76133
(817) 263-0962

2603 West Berry St.
Fort Worth, TX 76109
(817) 923-8259

6244 Lake Worth Blvd.
Lake Worth, TX 76135
(817) 238-0385

4520 Western Center Blvd.
Haltom City, TX 76137
(817) 514-8063

9625 White Settlement Rd.
Fort Worth, TX 76108
(817) 367-3469

1317 S. Main
Weatherford, TX 76086
(817) 594-5771

4520 Western Center Blvd.
Haltom City, TX 76137
(817) 514-8063

1050 E. Hwy 377
Granbury, TX 76048
(817) 578-3120