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W. Brad Gates
American Board of Family Medicine
3108 Midway Rd, Suite 105
Plano, TX 75093
Phone (972) 801-9100
Fax (855) 753-3285
For Life-Threatening Emergencies Call 911
NEW PATIENT FORMS
Please print and complete the Patient Forms listed below and bring them with you to your appointment along with your insurance card and drivers license. Please arrive 15 minutes early for your scheduled appointment.
Medical History (Pediatric for patients under 18 years old),
Consent to Share Medical Information, and
Consent and Acknowledgement
Please review the Financial Policies and Privacy Practices for our office prior to signing the Consent and Acknowledgement form.
The Release of Records form may be used to request records from previous providers, share records with other providers or forward your records to a new provider. Patients over 18 years of age and wish to share medical information with family members must complete the Consent to Share Medical Information form.
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