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Patient Info & Forms
Participating Insurance Plans: 

   Aetna Medicare Advantage PPO/POS
   Aetna PPO/ HMO
   Ambetter
   Blue Cross Blue Shield HMO
   Blue Cross Blue Shield PPO
   Cigna PPO/OAP/HMO
   Coalition America (Formerly NPPN)
   Galaxy Healthcare PPO
   Healthcare Highways
   HealthSmart ACCEL/GEPO/PPO
   United Healthcare HMO Select
   United Healthcare PPO Choice/Options
   USA MCO
   Medicare

 

Patient Forms: 

New Patient Paperwork
Follow-up Visit Form
Pre-Procedure Instruction Sheet   (for Fluoroscopic Procedures)
Discharge Instructions & Information   (for Fluoroscopic Procedures)
Pre-Procedure Instruction Sheet   (for Ultra Sound Guided Procedures)
Texas Pain Treatment Center Privacy Policy
Authorization to Release Medical Information   (Please make sure it is completely filled out) 
 ** Please Note: There may be a fee for records requested. 
 
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