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| WELCOME to Metroplex Pulmonary & Sleep Center. |
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| PATIENTS FORMS: |
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 Patient Registration |
| Patient History Form |
| HIPAA Privacy Authorization Form |
| Medical Records Release Form |
| Patient Sleep Notice Form |
| Authorization for Release of Medical Information Form |
| EP Worth Sleepiness Scale Form |
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| NEW PATIENTS: |
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| Please take a few moments to read the following so that your initial visit will be more efficient. |
- Download forms and complete them prior to arrival at our office to avoid delays. If this is not possible, please arrive at least 15 minutes early to complete this paperwork.
- Please bring some form of picture identification, preferably your Driver's License, and current insurance card.
- Write down any questions that come to mind so that we can provide you with as much information as possible during your visit.
- Please contact us as soon as possible if you see you are unable to arrive at your scheduled appointment time. We ask for 24 hour notice for cancellation of any appointment.
- Please bring your current medications with you to your appointment. This includes inhalers, sprays, prescriptions, as well as over-the-counter, herbal, or alternative medications so that we can fully assess your current condition.
- Please bring with you or have your Primary Care physician provide us with any X-ray or CT reports, preferably on disk or film.
- Please bring your Primary Care physician information.
- If your insurance is an HMO, please bring your referral authorization.
- SLEEP PATIENTS - Please bring your CPAP machine and download card. Also, we will need the name of your oxygen or CPAP provider.
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| RETURNING PATIENTS: |
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- Please advise our staff of any changes in your address, phone contacts or insurance.
- Please contact us as soon as possible if you see you are unable to arrive at your scheduled appointment time. We ask for 24 hour notice for cancellation of any appointment.
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