Patient and Physician Forms

The following is a list of forms commonly used by our patients and physicians. If you have any questions concerning the forms below, you may either use our website to contact us, or give our office a call at: (512) 819-0132.

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NOTICE OF PRIVACY PRACTICES

This notice describes how health information about you (as a patient of this practice) may be used and disclosed and how you can gain access to your individually identifiable health information.

NEW PATIENT PACKET

All new patients are required to download, read, and sign this document before their first appointment. This packet includes Treatment/Release of Information Authorization, Notice of Privacy Practices, Confidential Information Release Form, and our Financial Policy.

PATIENT HISTORY

All new patients are also required to download, read, and sign this document before their first appointment. This form will provide the doctors with your medical history including allergies, family history, list of medications and other history.

BRONCHOSCOPY DISCHARGE INSTRUCTIONS

This document is a detailed list of the instructions that a patient is to follow after their bronchoscopy procedure has been performed.

PFT INSTRUCTIONS

This document is a list of instructions for the patient to follow previous to Pulmonary Function Testing. If the patient does not follow these instructions, the appointment may be re-scheduled.

BRONCHIAL THERMOPLASTY INSTRUCTIONS

This document contains instructions that patients are to follow before and after their bronchial thermoplasty procedure.

PATIENT CONSULTATION FORM

This form is for other referring physicians or patients to fill out if you would like to schedule an appointment.

MEDICAL RECORDS REQUEST

This form is for requesting the forwarding of your medical records.

AUTHORIZATION FOR RELEASE OF CONFIDENTIAL INFORMATION

This form authorizes us to be able to disclose your confidential information.