Thank you for your interest in our services -- please fill out the New Patient Application form below before your first appointment.
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NAVIGATION - do not use the "BACK" button on your browser to go back to a prior page - instead use only the buttons provided at the bottom of each page to navigate. Using the "BACK" button will take you to a prior webpage and close out the form.
HIPAA COMPLIANCE - this form is HIPAA compliant and uses SSL encryption to transmit your information. If you are concerned about filling in your application online, then please download the PDF version to fill out offline at this link.
MEDICARE PATIENTS - If you are a Medicare patient, then please contact us by telephone at 281-585-3500 for special instructions before proceeding.
This form will require approximately 10 minutes to complete.
Please wait for the HealthWorks and Alvin Health logos to appear at the top of this page before proceeding...