Hoffman Health Austin TX Drs. Robb Myra Hoffman 512-346-5164

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

Comments/Feedback Form

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

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.

Comments/Feedback Form
The form below allows you to let us know how well we are serving your needs. We require either an email address or phone number in case there is a need to contact you regarding your feedback. If you truly wish to remain anonymous, there's always the "555" phone number.

We'd like to share your comments with other patients. Give us permission to publish your comments with your first name, last initial and city if you wish. Again, if you wish to remain anonymous, tell us and your comment will be published with Anonymous for the name. Comments are published on the main page of this site in the right column.