1006 E. Hillside, Laredo, TX 78041
Downloadable Forms
In an effort to provide you with high quality service, we have provided the following forms online so you may review, fill out and bring them in with you in an effort to expedite your appointment.
If possible, the Financial Policy and Patient Information forms should be filled out prior to your first visit.
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Patient Information Form - English
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Información del Paciente - Español
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Financial Policy - English
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Politicas Financieras - Español
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HIPPA - English
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HIPPA - Español
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Patient Authorization - Assignment of Insurance
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Autorizacioin del Paciente - Asignacion de Aseguranza
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Patient Survey Form - English & Español
Insurance Information
- NETWORKS
- PHCS
- Multiplan
- Healthsmart
- Choice Care
- Aviant
- Texas True Choice
- Cigna
- Beech Street
- Aetna
- United Health Care
- Medicare
- Medicare Replacement
- Blue Cross Blue Shield
- Humana
- Coventry
- VISION PLANS
- Eyetopia
- Vision Service Plan (VSP)
- Block Vision
- Spectera
- Ameritas (Secondary Only)
- Cleat
- Opticare
- MEDICAID
- Molina
- Driscoll
- Superior
- Healthspring
- CHIP
- Molina
- Superior