• New Patient Intake Form

    Dear Patient, Please fill out this questionnaire to the best of your ability. This will ensure a much faster appointment with us since we can enter this information into your chart before you come, get your medical records from your referring physicians well in advance of your visit and we can verify that your insurance is active. The safety and security of your information is very important to us and we use the highest levels of security measures in the industry to ensure that we are HIPAA compliant - including SSL and data encryption and PGP protocols. We look forward to taking care of you. At Dallas Rheumatology, we don't just care for you, we care about you.
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  • By checking this box, I acknowledge that I have had an opportunity to read the practice privacy and financial policy as well as the electronics communication policy. I intend to keep my scheduled appointment. If I am unable to keep my appointment, I will call the practice before my appointment time and reschedule/cancel my appointment. My failure to do so may result in me being charged a $50 no show fee.*

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