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

 

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