Forms & Documents

Forms

At Plastic and Hand Surgery of North Texas, we understand you want to have your office visit run as smoothly as possible. To help facilitate this process, we have provided our patient forms online for you to download and complete before your visit.

Simply refer to the list below to find the patient form(s) you need, then click on the link to download, print, complete and bring them to your appointment. In order to protect your privacy, please do not email these forms.

What to Bring

• Anyone 18 or older must present a government form of ID such as a driver's license at check-in at each visit. Minors should be accompanied by a parent or guardian at every visit.

• Your Insurance Cards (Primary, Secondary, and/or Supplemental, if applicable)

• New Patient Paperwork for all new patients.  If you have not seen Dr. Nam Le in over three years, you will be considered a new patient as well.  We require updated paperwork every year thereafter.  

• X-rays, Medical Records, Test Results if not already faxed to our office

• Copay, coinsurance, or self-pay payment via credit card or cash. NOTE: Your insurance requires us to collect your copay and/or deductible if applicable at each visit.