Patient Forms

To download forms and information you need, click on the links below. You have the option to either complete a form now or complete the copy provided during check-in.

Behavioral Health and Psychiatry

PATIENT HEALTH QUESTIONNAIRE

Dental

HEALTH HISTORY AND CONSENT FORMS

FIRST DENTAL HOME VISIT FORM

HIPPA CONSENT FORM

Dallas ISD

MINOR MEDICAL CONSENT FORM

Diet and Nutrition Services

DIET RECALL INTAKE FORM

Pediatric Forms

AGES & STAGES QUESTIONNAIRES (ASQ-3) 9-48 MONTHS

LEAD RISK QUESTIONNAIRES

MODIFIED CHECKLIST FOR AUTISM IN TOGGLERS REVISED (M-CHAT-R)

TUBERCULOSIS (TB) QUESTIONNAIRE

Women’s Health Forms

POLICY OF ACCEPTANCE OF PATIENTS FOR OB SERVICES

OBSTETRICAL HISTORY FORM

PRE-ECLAMPSIA RISK FACTORS FORM

OBSTETRICAL ULTRASOUND INFORMED CONSENT FORM

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Our pharmacy offers FREE delivery, $4 generic drugs, lower out-of-pocket costs, and more.

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NOTICE:

Due to the increased prevalence of flu, COVID-19, and various respiratory infections, all patients and visitors experiencing respiratory symptoms wear a face mask, ensuring coverage of both the nose and mouth. If you do not have a face mask, we can provide you with one.

Patient Forms

Behavioral Health and Psychiatry

PATIENT HEALTH QUESTIONNAIRE

Dental

HEALTH HISTORY AND CONSENT FORMS

FIRST DENTAL HOME VISIT FORM

HIPPA CONSENT FORM

Dallas ISD

MINOR MEDICAL CONSENT FORM

Diet and Nutrition Services

DIET RECALL INTAKE FORM

Pediatric Forms

AGES & STAGES QUESTIONNAIRES (ASQ-3) 9-48 MONTHS

LEAD RISK QUESTIONNAIRES

MODIFIED CHECKLIST FOR AUTISM IN TOGGLERS REVISED (M-CHAT-R)

TUBERCULOSIS (TB) QUESTIONNAIRE

Women’s Health Forms

POLICY OF ACCEPTANCE OF PATIENTS FOR OB SERVICES

OBSTETRICAL HISTORY FORM

PRE-ECLAMPSIA RISK FACTORS FORM

OBSTETRICAL ULTRASOUND INFORMED CONSENT FORM

Patient Forms

2022 Impact Report

Make the Switch to the HHM Health Pharmacy

Sign-Up for Our Newsletter