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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Hospitals
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.