Patient Forms

New Patient Form

This form provides us with your medical history. Your thorough completion of this form will enable us to work more efficiently during our time together and will allow a means by which to reassess your status on future visits. It is important for you to complete these pages as accurately and as completely as possible.

To download and complete the form:

  1. Download
    Right (or left) click on the button above then “Save Target As…” or “Download linked file as…”
  2. Save the blank document to your desktop. PLEASE NOTE: Saving the form to your desktop is an important step — if you fill it out within your browser window, all your work will be lost.
  3. Open and complete the form using Microsoft Word.
  4. Email the completed document to

Additional tips:

If you don’t have Microsoft Word (or equivalent software), we reccommend you download and install OpenOffice. It’s the leading open-source software suite for word processing and more — and it’s free! To find out more, go to

If you have problems downloading or emailing the form, please call (713) 840-9355 or send us an email for assistance.