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BASIC NEW PATIENT FORMS
Complete these for your first visit.
Notice of Privacy Practices
There is no need to print Privacy Practices. 
Acknowledge that you read them in the document below.
Acknowledgement of Notice

New Patient Information

Confidential Patient History

Chief Complaint Worksheet

Informed Consent
MATERNITY & PEDIATRIC FORMS
In addition to Basic New Patient forms, complete these if you are seeing Dr. Myra for pregnancy or child care.

Case History for Pregnant Mothers

Pediatric Intake
ACCIDENT FORMS
Complete these if you have had an auto accident.

Personal Injury Questionnaire

Chief Complaints/Symptoms - Personal Injury
These are the forms to be filled out on your first visit to our office.  You should be instructed about which ones to fill out when you call for an appointment.  Complete the Basics and the Maternity/Pediatric forms for that type of visit.  Complete the Accident forms in addition to the basic forms except replacing the Chief Complaints under Basic forms with the Accident form of the same name.
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8727 Shoal Creek Blvd.  Austin, TX  78757           (512) 346-5164