Becoming A New Patient

Anyone interested in becoming a patient at TFWC is now required to complete an application. By submitting the application below, you acknowledge the following - 

*I've provided in connection with this form true & correct information to the best of my knowledge.  

*I also understand that any false statements or deliberate omissions on this form may subject me to be terminated as a patient of TFWC. 

*I understand that if I am late to my appointment, do not show up, and/or cancel within 24 hours of my appointment time, I may not be seen as a new patient at this clinic and may not be rescheduled. 

* I understand that this application submission is not a guarantee that I will be accepted as a patient.  

* I understand that Texas Family Wellness Clinic does not prescribe Narcotic Medications such as, but not limited to Hydrocodone, Codeine, Oxycodone, Opium, Xanax, Alprazolam , Clonazepam, Valium. 

* I understand that Texas Family Wellness Clinic does not prescribe weight loss medications.  

* I understand that I must submit my photo ID and the front and back of my insurance card to to verify my insurance benefits, along with this application.  (Selfpay patients must provide their Photo ID only) OPTIONS: upload photos to this application, text the photos to 361-600-7018 or stop by the clinic to have them photo copied. 

Once we've received this application, your photo ID and the front & back of your insurance card, please allow for 10 business days to process your information for consideration.