972-566-4591

Forms and Resources

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 media@holinergroup.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:
New Patient Forms – English
New Patient Forms – Español
New Patient Forms – Scott Thornton ONLY
New Patient Forms – Camille Holiner ONLY
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)
Scott Thornton Medical Release Form
Camille Holiner Medical Release
Camille Holiner Credit Card Authorization 

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:
Billing Policy
Prescription Policy
Red Flag Policy

Below is a list of insurance companies we currently accept.

United Health Logo


** Please be advised that if your insurance plan is not listed above you may call our office (Dallas: 972-566-4591) to verify that it is an accepted plan as the list may change periodically.

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Have a Question? Let’s discuss it.

  • View our list of Insurance companies we currently accept.

    Any message submitted cannot be guaranteed to be received, read or answered, within any specific timeframe. PLEASE DO NOT submit sensitive or confidential information via email. The Holiner Psychiatric Group cannot guarantee the delivery and/or confidentiality of any email message submitted. A physician is on call for urgent matters after office hours. If this is a medical emergency, please call 911. For the National Suicide Prevention Lifeline, please call 1-800-273-TALK (8255)

 

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