New Patients please complete the following forms:

If forms are completed arrive 20 mins prior to appointment with insurance card/photo ID and medical records. Please note new patients that do not call to cancel a first appointment are considered a “No-show” and are not allowed to schedule future appointments. We appreciate all patients arriving a few minutes early so that we are able to see all patients at their scheduled times. New patients should bring their insurance cards and a list of all medications in use to the first visit.

*Please fill out new patient forms ONLY if you have a scheduled appointment at South Austin Medical Clinic*

Registration Forms

Adult New Patient Forms required for 18yrs & older

Pediatric New Patient Forms required for 0-17 yrs

COVID-19 SCREENING QUESTIONNAIRE

Authorization for release of protected information

Consent to treat a minor 

Please only complete forms below as requested by your physician prior to your scheduled appointment 

PHQ-9 

GAD-7   

 Adult ADHD Self-Report Scale 

Mood disorder Questionnaire 

Other useful forms 

CCM Referral  (pdf) Please print name and date of birth on form.