Patient Forms and Downloads

Below are links to PDF downloads for the most common information & forms used at TCRS offices.

(If you have trouble downloading any information, please install Adobe Reader 9.0)

If you are a new patient, please make sure to print and sign both the New Patient Medical Registration Packet and the New Patient Financial and Privacy Consent Packet. Thank you.

New Patient Medical Registration Packet
If you are a new patient, please download and fill out the medical forms above to bring with you to your appointment.

New Patient Financial and Privacy Consent Packet
If you are a new patient, please download and fill out the financial and consent forms above to bring with you to your appointment.

TCRS Privacy Policy 
Your privacy is important to us, please review the TCRS privacy practices that follow HIPAA regulations.

Accepted Insurance Carrier List
TCRS participates with most major insurance companies, download the current list of carriers to see if yours is accepted.

Medical Records Request and Authorization to Release Form
If you would like to request or release your medical records to or from a Texas Colon & Rectal Specialists office, please download authorization form and send to appropriate TCRS office.

Patient Satisfaction Survey
Please share your experience with us by filling out this Patient Satisfaction Survey. We strive to exceed your expectations and your opinion matters to us!




Online forms may require that you download and install the latest version of Adobe Reader

 

11551 Forest Central Drive
Suite 133
Dallas, TX 75243
Toll Free:1.877.275.8277
Local: 214.343.8565
Fax: 214.342.3054
Copyright © 2010 . Texas Colon & Rectal Specialists. All Rights Reserved.