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PHYSICIAN PROFILE |
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FORMS |
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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.
(Para obtener este formulario en español, por favor oprima aquí)
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 este formulario en español, por favor oprima aquí)
Financial Policy
Explains payment of services
(Para obtener este formulario en español, por favor oprima aquí) |
Authorization to Release Medical Information FROM MCNT
Authorizes Medical Clinic of North Texas, P.A. to release your medical information to specific entities.
(Para obtener este formulario en español, por favor oprima aquí)
HIPAA Patient Education - Frequently Asked Questions
HIPAA as it relates to our patients.
(Para obtener este formulario en español, por favor oprima aquí)
Request for Correction / Amendment to Record
Allows you to request a correction / amendment to your medical record.
(Para obtener este formulario en español, por favor oprima aquí)
Know Your Benefits
This pamphlet can assist you in learning about your insurance benefits, including questions to ask your provider.
(Para obtener este formulario en español, por favor oprima aquí)
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24-Hour Pharmacies |
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| Walgreens |
CVS |
6244 Lake Worth Blvd.
Lake Worth, TX 76135
(817) 238-0385 |
3614 Camp Bowie Boulevard
Fort Worth, TX 76107
(817) 870-1873 |
3100 Mccart St.
Fort Worth, TX 76110
(817) 924-5126
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2603 West Berry St.
Fort Worth, TX 76109
(817) 923-8259 |
6205 Westcreek Dr.
Fort Worth, TX 76133
(817) 263-0962
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8660 US Highway 377 South
Benbrook, TX 76126
(817) 249-4040 |
4520 Western Center Blvd.
Haltom City, TX 76137
(817) 514-8063 |
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9625 White Settlement Rd.
Fort Worth, TX 76108
(817) 367-3469 |
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6984 Rufe Snow Dr.
Fort Worth, TX 76148
(817) 427-9353 |
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1317 S. Main
Weatherford, TX 76086
(817) 594-5771
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4520 Western Center Blvd.
Haltom City, TX 76137
(817) 514-8063
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1050 E. Hwy 377
Granbury, TX 76048
(817) 578-3120
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Other Physician at the Lake Worth location |
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| R. Kendra Dabelic, M.D. |
Lynn Marie Speaks, D.O. |
 Family Medicine
Board Certified by the American Board of Family Medicine
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 Obstetrics & Gynecology
Board Certified by the American Osteopathic Board of Obstetrics and Gynecology |
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SERVICES OFFERED |
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HOSPITAL AFFILIATION |
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As a woman, the selection of an OBGYN doctor is a highly personal choice. Our physicians offer excellent professional health services to fill your individual needs.
Our highly trained physicians can assist you with all gynecological services and can guide you through pregnancy and birth.
To learn more about Obstetrics & Gynecology, please visit the American College of Obstetrics and Gynecology at http://www.acog.org/. |
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- New Patients Always Welcome
- Same-Day Sick Visits Available
- Accepts Most Major Insurance Plans and Medicare
- Complete Health Care Services for Women
- Physicals
- Lab Work
- Gynecological Exams, Family Planning
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Harris Methodist Fort Worth Hospital
1301 Pennsylvania Avenue
Fort Worth, TX 76104
817-250-2000
www.texashealth.org |
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Copyright
. All rights reserved. Site designed and developed by the Medical Clinic of North Texas, P.A.
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