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Patient Forms

Call (713) 468-5800
  • Houston, Texas - 8391 Westview Drive 77055
  • Houston, Texas - 9809 Rowlett Rd, Suite B 77075
  • (713) 468-5800 | Houston, Texas - 8391 Westview Drive
  • (713) 468-5800 | Houston, Texas - 9809 Rowlett Rd, Suite B

 

If you are a new patient to our office, below you will find our new patient forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

English

PATIENT REGISTRATION
MEDICAL HISTORY
ASSIGNMENT OF BENEFITS AGREEMENT
NOTICE OF PRIVACY PRACTICES ACKNOWLEDGEMENT


Español

MATRICULA DE REGISTRACIÓN
HISTORIAL MEDICO
ACUERDO DE ASIGNACIÓN DE BENEFICIOS
EL AVISO DE LA AISLAMIENTO PRACTICA EL RECONOCIMIENTO

 

 This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

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There is a twenty-four (24) hour answering service that can get in touch with Dr. Hernandez in cases of emergency. Please fill out the form below to email us.
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