PATIENT INFORMATION

For your convenience we have supplied most of the documents that we will need during your first visit.


Please let us know if you have any questions and we will be more that happy to assist you with any of these forms.


If you decide to fax these documents please fax with doctor prescription, photo id and insurance card if possible. To be certain that all documents have been received follow up with a phone call to our office.


Office: 817-336-8293

Fax: 817-336-9017

HIPPA FORM

This form is required for every Brace Center patient

HIPPA FORM

PATIENT RESPONSIBILITIES

Each patient should bring their prescription, insurance identification/eligibility card, insurance forms, HMO/PPO forms, and other pertinent information upon their first visit to our facility. 

DVF FORM

DIABETIC VERIFICATION FORM

This form is required for any patients that are receiving Diabetic Shoes and Inserts. This form needs to be completed by the treating physician of diabetes.

DVF FORM