Patient Forms


 

MAKE AN APPOINTMENT

HOSPITAL AFFILIATIONS

St. Luke’s Episcopal Hospital
Memorial Hermann Hospital-Texas Medical Center
Methodist Hospital


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.


Office Policies

Notice of Privacy Practices - 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.

Preferred Contacts Form - Patient Preferences for Communication

Care Instructions - Laser Lipo / Cavitation Before & After Care

Authorization to Release Patient Info - Permission to share patient medical records

Authorization Consent to Treat - Assignment of Benefits and Authorization to Release Medical Information. Guarantee of Payment

SACHW Weight Loss Intake With Consents - Weight Loss Management Intake Forms

Snatched Intake with Consents - Laser Lipo/Cavitation Intake Forms

 

 

Location
Supreme All Care Health and Wellness
201 Kingwood Medical Dr., Suite A-400
Kingwood, TX 77339
Phone: 832-225-8384
Fax: 832-412-8009
Office Hours

Get in touch

832-225-8384