Simply click on the links below to download, print, complete and bring the forms to your appointment. In order to protect your privacy, please do not email forms.
- New Patient Registration Form: English | Espanol
- Consent to Treat Form: English | Espanol
- History and Physical Form
- Medication Chart
- Pain Medication Policy
- Patient Controlled Substance Agreement
- Authorization for Health Care Information Data Exchange
- Notices of Privacy Practices Acknowledgement
- Pain Questionnaire - Back
- Pain Questionnaire - Neck
Note: The forms are saved in Adobe® Acrobat. If you would like to read, use the form features or print the Adobe files, you will need the Adobe® Reader (version 5.0 or later). Download Adobe Reader for free.
We believe in enabling our patients to focus on maintaining good health and receiving quality care. North Texas Neurosurgical and Spine Center accepts most major insurance plans, Medicare and various forms of payment, and will verify benefits prior to your appointment. Please call us at 817-250-4280 with any questions.
Pay a Bill
In order to use the payment portal to pay your bill, please have your statement and billing information readily accessible. For question or payments by phone, call us at 1-800-890-6034.
In the News
Dr. Tanya Dixon
Dr. Cyrus Wong
- Patient Success Story: Meet Justin Vickery
- WFAA: Veteran has new lease on life after doctor removes spine-crushing tumor
- Oh, Our Aching Backs
Dr. Farhan Siddiq
- Fort Worth Star-Telegram: What we know about the disease Travis Frederick is fighting
- Fort Worth Star-Telegram: Good signs: Cowboys’ Travis Frederick attending team meetings, watching practice from sideline
- KERA NEWS: Doctors Now Have More Time to Save More Lives of Stroke Victims
- WFAA Good Morning Texas – Stroke Awareness with Dr. Farhan Siddiq
- NextAvenue: Heat Stroke is Especially Dangerous, Even Deadly, in Older Adults
- Why Aren’t There Routine MRI Screenings for Brain Aneurysm?
- Getting an MRI if a Family Member Has an Aneurysm
- Can Aneurysm Cause One Pupil to Be More Dilated than the Other?
- Can a Brain Aneurysm Cause Head Stabbing Pain?
- Can an Unruptured Aneurysm Cause Headaches?
- Exercise Guidelines after Brain Aneurysm Coiling or Clipping
- Can You Hear a Brain Aneurysm Rupture?
- Can a Brain Aneurysm Cause Headaches on One Side?
- Can an MRI Miss a Head Injury and Not Show It?
Open AllClose All