OmniTelamed is launching July 1st, 2021!
Serving fellow Texans from the comfort of their home.
Patient Registration Forms & Privacy Notices
- If you are a new patient, please fill out the registration forms listed below in advance of your appointment to assist the staff in making sure that we have all the information necessary to provide you with quality care and treatment.
- Please bring the completed forms with you to your appointment.
- Medical Records Release
- Patient Consent and Registration
- Consent for Treatment of a Minor
- Patient HIPAA Acknowledgement and Consent
Please complete one of the forms below
- Pediatric Health History (patients 16 years of age and younger)
- Adult Health History (patients 17 years of age or older)
Patient Rights & Responsibilities
We respect our patients’ dignity and pride. This page (link below) will explain your rights and responsibilities as a patient. It is part of your patient registration, and it is an important part of your health care plan.
This privacy notice describes how health information about you may be used and disclosed and how you can get access to this information.
- Notice of Privacy Practices