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New Patients |
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Welcome to our practice!! Our purpose is to provide quality medical care in a fun and loving atmosphere, so that people feel better when they leave than when they came. We are glad you have chosen Arlington Family Practice to partner in your health care needs. |
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Below you will find the following forms: Health History, New Patient Consent Form, Financial Policy Form, Adult Vaccine Questionnaire, and the Authorization for Use of Personal Health Information. Please complete these forms and you may do one of the following after you print them out: |
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1. Bring them with you to your appointment, or; |
2. Fax them to 817/632-9648 for the Arlington office (Drs. Sharon Dennis, Greg Dott, David Gouldy, and Tien Truong) and 817/612-6639 for the Mansfield office (Dr. Trayce Orr) along with this fax cover sheet. | |
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When you come to the office, please bring all your necessary insurance information and your driver’s license or picture ID. In addition, we want to let you know we accept cash, credit cards or debit cards only for payment of services |
Please take a moment to read through our Notice of Privacy Practices and let us know if you have any questions when you arrive for your appointment. |
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Thank you for allowing us to participate in your healthcare needs and we look forward to seeing you. |
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| Yours truly, |
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The Doctors and Staff of
Arlington Family Practice, P.A. | |
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