Patient Information

Frisco Spine

Patient Forms

Below are some of our forms. If you are unable to print at home we are happy for you to complete them at the office. Please arrive 15 minutes before your scheduled appointment to allow time to process forms. If you are a new patient to our practice please complete Forms 1 through 4. Please bring the completed forms with you to your appointment. If you are a returning patient and your name, insurance, address or phone has changed since your last visit to our office, please complete form 1.

Name Description   Last Updated

New Patient Forms

If you are a new patient please print and fill out forms 1-4.

   
1  Patient Demographics This form collects all information the office needs
to bill your insurance or contact you.
5/9/2013

2  Consent to Release- Personal Health Information

see file for information 5/9/2013

3 Physician Information Sheet

see file for information 5/9/2013
4 New Patient Questionnaire see file for information 5/9/2013
5 Pharmacy Information see file for information 5/9/2013
6 Office Policies see file for information 5/9/2013
Forms 1-6 Combined Forms 1-6 Combined 5/9/2013
7 Authorization of Release see file for information 5/9/2013
8 Authorization of Release-Compound see file for information 5/9/2013
9 Notice of Privacy Practices see file for information 5/9/2013
10 Acknowledgment of Privacy Practices see file for information 5/9/2013
       

Additional Forms

     
 Follow-up Patient Questionnaire This form is completed by all returning patients.  It updates the physician on the patients’ current condition. 5/9/2013
Surgery Information  This is the packet we provide to our patients when
surgery is scheduled.  We provide it here for your review.
6/30/2010
       
       

Insurance Information

Everyone deserves to enjoy a life without back pain, which is why Frisco Spine proudly accepts a number of different insurance plans. We are constantly expanding our list of accepted providers so if yours is not listed here, please call us to double-check for coverage.

Insurance affiliations include: 

  • Accountable PPO
  • Aetna HMO / PPO
  • Aetna Medicare
  • Blue Cross / Blue Shield PPO / POS / HMO
  • Beechstreet / PPOnext PPO
  • Care Improvement Plus
  • Cigna HMO / PPO
  • Choicecare PPO
  • Choicecare Medicare
  • Choicecare Medicare Advantage
  • First Health PPO
  • Galaxy PPO
  • Great West PPO / POS / Open Access
  • Integrated Medical Systems PPO
  • Medcorp SW PPO
  • Medicare
  • Planvista (NPPN) PPO
  • Healthsmart / NTHN EPO / PPO / GEPO / POS
  • PHCS / Multiplan PPO
  • Principal PPO
  • Texas True Choice
  • Tricare
  • Unicare PPO
  • United Healthcare PPO / All Other / Secure Horizons

Hospital Information

Hospital affiliations include:

  • Baylor Hospital, Carrolton, TX
  • Baylor Hospital, McKinney, TX
  • Baylor Hospital, Plano, TX
  • Centennial Hospital, Frisco, TX
  • Denton Regional Hospital, Denton, TX
  • Forest Park Hospital, Dallas, TX
  • Medical Center of Lewisville, Lewisville, TX
  • Medical Center of McKinney, McKinney, TX
  • Medical Center of Plano, Plano, TX
  • Paris Regional Medical Center, Paris, TX
  • Presbyterian Hospital, Flower Mound, TX
  • Presbyterian Hospital, Plano, TX
  • Texoma Medical Center, Denison, TX

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