Patient Forms

Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. Autorización De HIPAA Para Divulgar Información Del Paciente

Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento

Preferred Contacts (PDF) - Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos

Virtual Visit Policy (PDF) - This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.

Office Policies

Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations. Política Financiera (PDF)

Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully. Aviso de prácticas de privacidad (PDF)

HIPAA Privacy Notice

Additional Patient Forms

Thank you for choosing Endocrine Associates of Dallas & Plano (EAD) for your health care needs. Our doctors are dedicated to providing the highest standards of care by offering the most technologically advanced treatments available tailored to the needs of each individual patient. EAD’s physicians are internal medicine speciality doctors (endocrinologists) in endocrinology, diabetes, hormone therapy and metabolism (obesity) who have offices located in Dallas and Plano Texas.

Please read the following patient information for your upcoming visit with Endocrine Associates of Dallas & Plano.

Our office will need a completed “Patient Information and Consent” form for ALL new patients.
New adult patients will also need to complete the “Adult Health Questionnaire”.
If you are bringing a child for a first-time office visit, we will ask you to complete the “Pediatric Health Questionnaire” as well as the “Patient Information and Consent form”.

What to Expect During Your First Visit

Endocrinology involves evaluation of hormones. This testing requires blood. During your evaluation, obtaining a blood sample will be requested.

It is important that our patients be prepared for their visit. In addition to testing of blood and urine, it is important that our patients be prepared for a full examination.

Pediatric patients will have a complete physical examination to determine pubertal/developmental staging.
Men with concerns of testicular dysfunction often need genital and prostate exams.
Women with abnormal hair growth or breast secretions, may need evaluation of the breast and/or genitalia.

Completing Your Patient Forms

All forms are provided for new patients at our office. However, it does take a bit of time to complete them. For your convenience, you can download and print these documents from this website and complete them at home to bring to your first office visit. Due to legal requirements, please sign and date these forms in person during your office visit.

Please click on the form you need to download and print:

If you would like to learn more about disorders of endocrinology, diabetes, hormone therapy and metabolism (obesity), please arrange a consultation with one of our doctors. You may submit an online appointment request or call one of our Endocrine Associates of Dallas or Plano offices.

Forms can be completed online through the patient portal or you can print them from our website and bring them with you to your appointment.