New patients
New Patient Form
Print the intake at home, fill it out, and bring it with you. We do not collect protected health information on this website.
Printable intake PDF
The packet covers demographics, contact details, accident information (if any), a symptoms and pain diagram, health history, medications, and consent / HIPAA acknowledgment signature lines.
PDF opens in a new tab. Print on letter-size paper. Bring the signed pages to your visit.
How to use this form
- 01
Download and print
Use the button above. One packet per patient.
- 02
Fill it out at home
Use ink. Parents or guardians sign for patients under 18.
- 03
Book your visit
Schedule on our booking page (Calendly) or call (214) 484-2629. Booking collects only scheduling details — not clinical history.
- 04
Arrive about 15 minutes early
Hand the completed packet to the front desk. If you could not print it, we have paper copies at the clinic.
What to bring with the form
- Photo ID
- Health insurance card (if you plan to use it)
- Auto insurance card and claim number after a crash
- Medication and supplement list
- Any ER, urgent care or imaging paperwork
- Attorney contact details only if you already have one (optional)
Clinics
Richardson
1651 N Collins Blvd, Suite 124, Richardson, TX 75080
Parking is available in the building lot at no charge. Suite 124 is on the first floor; follow lobby signage to Howill.
Hours: Mon–Fri, 9 AM – 5 PM
Arlington
2000 East Lamar Blvd, Ballpark Way #600, Arlington, TX 76006
Parking is available at the East Lamar / Ballpark Way business center. Check in at suite 600 for your appointment.
By appointment only
Questions about the form? Call the clinic. For emergencies, call 911.
Book after you print
Scheduling is separate from intake. Choose a time, then bring your completed PDF.
Book an appointment