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Patient Forms
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.
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Insurance Information
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.
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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.
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We would like to thank you for your interest in North Texas Neurosurgical and Spine Center. It is our desire that all our patients be as informed as possible. Hopefully, some of your questions about our services and office policies will be answered on this site. For your convenience, we offer our patient forms online, as well as insurance and billing information.