 |
| How
To Become A Patient |
To make an appointment
call 817-625-4254. On the day of your appointment please bring
the following:
|
| • Birth dates for all family members |
 |
| • Proof of Income (last 2 pay stubs for
both husband and wife) |
| • Picture ID (a picture id
with your current address) |
| • Complete Insurance Information, if available
(company?s name, member of family covered, policy number, and
type of coverage] |
• Medicaid or Medicare Card (if
available)
|
• Proof of Address (Utility bill
with current address)
|
• Social Security numbers for both
husband and wife and/or child if patient (if available)
|
• If you do not have insurance,
when you register we will determine what percent of the
actual clinic cost you will have to pay. We charge a sliding
scale fee based on your income and family size.
|
Appointments are Encouraged, but Walk-Ins are Welcome !
Download and complete the following form to bring with you:
FORMA DE REGISTRACION DEL PACIENTE
PATIENT INTAKE FORM - ENGLISH
PATIENT HISTORY FORM - EN ESPANOL
PATIENT HISTORY FORM - ENGLISH
|
2106
N. Main Street
Fort Worth, Texas 76164 |
Hours of Operation
Mon, Tue, Wed, Fri 8-12 and 1-5
Thursday 8-12 and 1-8pm
Make an appointment Today! |
