Patient Forms

To save time during your first visit with us download and print the documents below. Then, bring them completed with you to your appointment, as well as your picture I.D. and insurance card.

Patient Information - Download & Print Form

Surgery Cancellation Policy - Download & Print Form

Medical Records Release to ASNTX - Download & Print Form

Financial and Privacy Policy - Download & Print Form

Medical History Questionnaire - Download & Print Form

ASNTX Privacy Policy - Download & Print Form

FMLA Forms - Download & Print Form

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Dr. Duffy and Dr. Cottrell both perform procedures at multiple hospitals and surgery centers throughout North Texas. We will recommend the most appropriate facility for each patient based on their individual circumstances. Contact us at 972-439-3753 for further questions or to schedule an appointment.