New Patient Intake Forms
Please review and complete the patient intake packet prior to your appointment. Thank you!
Download and Complete the New Patient Forms:
- Download HERE then print and fill this form out (on your computer).
- Print and bring them to your appointment OR you may fax them to 214.453.2142.
- Your signature is required, sign where requested. We need ORIGINAL signed documents.
- Make sure your name is printed at the top of each page.
- Please print very clearly.
“Appointment Date” is the date of your appointment.
Medical History Pages:
It is IMPORTANT that you complete this as thoroughly as possible. Please prepare additional pages if you need to more fully explain any item than space provides.
Note: You are responsible for the accuracy of the information you provide. Please let us know if you are not sure of an answer or if you feel verification is required.
When You Arrive
At the time of your appointment you will also be provided with standard arbitration, HIPAA notices and medical release forms to be signed.
What to bring:
- Your latest labs.
- Your insurance card.
- Your driver’s license.
Reclaim Internal Medicine
3900 S. Stonebridge Drive, Suite 1404
McKinney, TX 75070 USA
Monday: 9:00am – 6:00pm
Tuesday: 8:30am – 5:00pm
Wednesday: 9:00am – 6:00pm
Thursday: 8:30am – 5:00pm
Friday: 8:30 – 1:00pm
Relax! We understand that traffic can be bad or a meeting may cause you to leave later than expected.
If you are running late, please do us the courtesy of calling us and letting us know so we can better manage our schedule.