PATIENT INFORMATION

NEW PATIENT FORMS

For your convenience, you may print and complete the below forms prior to your first visit. Please scan and send to jwfrontdesk@johnwestpt.com or FAX to (713) 790 – 0254. You may also include a copy of your insurance card as well as your driver’s license and medical prescription to expedite the verification process.

HIPAA
PRIVACY NOTICE

PATIENT
RESPONSIBILITY

MEDICAL
HISTORY

INSURANCE

PLEASE CALL US TO VERIFY BENEFITS!

WE ACCEPT MOST PLANS FROM THE COMMERCIAL COMPANIES LISTED.

PLEASE CONTACT US DIRECTLY IF YOU DO NOT SEE YOUR HEALTH PLAN BELOW.

Altrua HealthShare

Blue Cross Blue Shield

Cigna

Humana

Medicare Part B

TriWest (Veteran's Affairs)

United Healthcare