Patient Forms

For your convenience we have many of our forms available online. Please print them and have them completed and ready when you come in for your appointment. If you are unable to do so ahead of time we also have these forms available when you come for your visit; please arrive 5-10 minutes earlier to allow time for you to fill these out.

Forms For New Patients

New Patient Intake Form
New Patient Demographics
Financial Policy
HIPAA Explanation Form
HIPAA Release Form
Consent for Treatment of a Minor

Forms for Annual/Wellcare Patients

Annual/Well Exam Questionnaire
Men
Women
Annual Letter

Other Forms

Flu Vaccine Consent Form
Letter to Medicare Patients
Medicare and Secondary Off-Assignment Insurance Instructions
Pediatric Specialist Referral List
Release of Information
Specialist Referral List
Surgeon Referral List
Clinical Pathology Laboratories
Adobe Acrobat Reader is required for viewing all of the above.
News::

Healthy Eating

Eating healthy is important to overall health and wellness. Recently Dr. Hausman-Cohen, along with personal chef Leah Grace Rizzo, taught a healthy easy cooking class series using recipes from hers and Dr. Weston’s kitchens. We have now posted the recipes we prepared and shared at this class series on our website. If you are looking for easy recipes or expanding your healthy cooking repertoire then you may want to check these out. They can be found on our new recipe page





© 2006 Balcones Woods Family Medicine