Forms And Policies

OFFICE HOURS: (with appointments daily)

Monday – Thursday 8:00am to 5:00p, Friday 8:00am to 12:00pm

Below you will find our forms available for download. You will need Adobe Reader in order to view these forms. After completing the forms, you can email them to ho**************@**********up.com or text forms to 972-566-4591. Please note the text feature is for registration forms, Insurance Cards and ID’s only. If you have other concerns or issues you must call us at 972-566-4591.

Forms

Opioid Partial Agonists Contract – English

Opioid Partial Agonist Office FAQ’s

Patient Health Questionnaire

Patient Release Forms

Verbal Authorization Form

Verbal Authorization Form (Español)

Medical Release Form

Medical Release Form (Español)

Patient Handouts/Resources:

Medication Side Effects Information

New Patient Handout- What to Bring and Expect

Bibliotherapy and Self Help books (all topics and categories)

Eating Disorder Resources

Electroconvulsive Therapy Resources

Internet Resources (all topics and categories)

Office Policies

Office Policy

Prescription Policy

Insurances We Accept