Save time by filling out the new patient information form in advance

Convenient new patient information form

IMPORTANT INFORMATION FOR PATIENTS

To save time on the day of your appointment, please download, print, and fill out the form we’ve provided for our mutual convenience. Please return your new patient information form along with your drivers license, insurance cards and a list of your medication at least 2 days prior to your appointment. You may bring it by in person or fax it to 940-687-7005.

Every effort is made to respect your time and keep delays to a minimum. A sincere effort is made to follow our schedule of appointments. If you are unable to keep your appointment, please notify our office 24 hours prior to your appointment time.

IMPORTANT INFORMATION FOR PATIENTS

Copayments are due at the time of your visit. If your deductible has not been met for the year, payment will be due at the time you are seen. Payment may be made by cash, check, VISA, Mastercard or Discover.

INSURANCE INFORMATION

North Texas Surgical Group participates with many insurance carriers. Please verify with your insurance company prior to your appointment that we are in your network. We will submit all charges to those carriers. You will be responsible for any co-insurances, deductibles or services that are not covered by your plan.

If your insurance requires you to have a referral, it will be your responsibility to retrieve one from your family doctor. If you do not have a referral, we may need to reschedule your appointment to a later date. If you wish to be seen without a referral, you may be financially responsible for the service that is provided.

We participate with BCBS PPO, Cigna, Healthsmart, United Healthcare, UMR,Tricare, Humana, Medicaid, and Medicare. Please contact your plan to verify if we are in network if it is not listed above.