Patient Info

Complete The New Patient Form

Please complete the form below, and allow up to 2 business days for your request to be processed. Please be aware that submission of this form does not guarantee your appointment. If you would like to schedule an appointment sooner, please call our appointment center at 713-462-6565, press option 3 for assistance with scheduling an appointment. Our schedulers are available Monday through Friday from 8 am to 5 pm.

Appointment Form
Time for Appointment Request
What is your address? (required) *
What is your address? (required)

Insurance Information

Do you have medical insurance?
Is the patient the subscriber? (required) *

Appointment Preference

Is there a specific doctor you're requesting?

Registration Form Download
New Patient Forms are found above, you can print them out, or submit your New Patient Form here.

Forma de registro
Forma de registro se encuentra en el botón superior. Puede imprimir los documentos o enviarlos electrónicamente aquí.

Upload New Patient Form
Maximum upload size: 1MB
(PDF files only)

Insurances Accepted

Aetna - Commercial, Medicare, Marketplace

Ambetter by Superior - Commercial, BH

Amerigroup - Star, Star+, Chip, Starkids, Medicare, Dental,


Assurant Health

Blue Cross Blue Shield - Commercial, Marketplace, Medicare

Beacon Health Strategies - Medicaid, Star, CHIP

Care Improvement


Community Health Choice - Star, Star+, CHIP, CHIP Perinatal, Marketplace


Guardian Life Insurance

Humana - Commercial, medicare, Marketplace




Medicaid - Traditional, Star, CHIP

Met Life

Molina - Star, Star+, CHIP, CHIP Perinate, Medicare, Marketplace

Multiplan Network

Optum BH

Superior - Star, Star+, CHIP, CHIP Perinatal, Marketplace (Ambetter)

Texas Children's - Star, Star+, CHIP, CHIP Perinatal


United Healthcare - Star, Star+, CHIP, Medicare Advantage Plans (AARP), Commercial, Marketplace


Notice of Client Privacy Rights

  • Lab Test Results
  • No-Show
  • Appointments
  • Walk-ins
  • Medication Refills
  • Release of Information
  • No Show

Your PCP is the doctor, nurse practitioner, physician assistant or clinic that gives you care. Your insurance coverage and benefits may change from time to time and that may require changing your PCP.  We encourage you to change your PCP after you’ve scheduled an appointment with us.

You may request a different PCP at any time.  You do not have to wait until Open Enrollment to change your PCP.  Be sure to confirm the “effective date” of the new PCP when you make the change.

  1. Call your medical plan’s customer service number to request the change. You can find the number on your medical ID card.
  2. Ask the insurance representative when the PCP change will be effective. If you call the medical plan before the 15th of a month, the change will be effective the first of the next month. If the change is made after the 15th, it will be effective the first of the next month
  3. Use your medical plan’s website to search for a PCP.
  4. Each family member may choose a different PCP from the doctors who are contracted with your medical plan.
  5. Request a transfer of medical records from your provider.

Please read our Privacy Policy

We value your support

We appreciate the invaluable support from our donors and volunteers. With your help, we are able to continue providing the best possible healthcare to our patients.

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