Please note: The links below point to .pdf forms that must be completed and printed, with a hard copy brought along when checking in for an office visit.
Patient Registration Form:
English
Large Print Version
Formulario de registro del paciente
Versión de letra grande
Patient History Form:
English
Formulario de historia del paciente
Authorization to Treat:
English
Autorización para el tratamiento de un menor de edad
Patient Release of Information:
English
Divulgación de información al paciente
Please mail all requests for medical records to:
Vital-Chart (VRC)
3000 Roy Orr Blvd. Ste 120
Grand Prairie TX 75050
Phone:
972-399-0914
Fax:
682-236-0038
Email:
THPG@vital-chart.com