The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time you will save significant time at the time of your visit. If you have any questions when filling out these forms, please do the best you can, our staff will assist you with your questions on the day of your visit.
**Please bring your insurance card(s), valid photo identification, and list of current medications to every office visit.**
Please print and complete the Patient Registration forms below:
We accept most major insurance policies, including Medicare, and also accept self-pay patients. Please contact the office if you have specific questions regarding your insurance plan. Our office will verify your benefits and obtain any required referrals prior to your appointment.
Deductibles, co-insurances and copays are due at the time of service. Cash, check and most major credit cards are accepted. Regardless of third party payments, the ultimate financial responsibility rests on the patient or responsible party. If alternate financial arrangements need to be made, please speak to our office reception at least 24 hours prior to your visit to obtain an authorization.
It your responsibility to notify your pharmacy or our office when prescription medication refills are needed. Refills will only be addressed during regular office hours. Refills will NOT be addressed on Saturdays, Sundays or holidays.
Approval of your refill can take up to three business days and approval will take longer if a prior authorization is required by your insurance company; please do not wait until you are out of medication.
Please use the link below to pay your bill online.
Please use the patient portal to ask questions, access your account information, and view your medical records from the comfort and privacy of your personal computer or mobile device.
7505 Glenview Drive, Suite G, North Richland Hills, Texas 76180 | Phone: (817) 284-9225 | Fax: (817) 590-0079
915 South Main Street, Suite A, Fort Worth, Texas 76104 | Phone: (817) 284-9225 | Fax: (817) 590-0079
Lung & Sleep Center of North Texas © 2017 – All Rights Reserved