Home   >   Forms

FORMS

Save you time

FORMS

Every effort has been made to consolidating forms to save you time. Therefor everything in the forms are of the utmost importance to provide you the best patient care possible.

  • If you are a physician, or work in a doctor’s office, simply fax us the Patient Registration Form. (Spanish)

  • If you are a patient going to visit your physician, print out the Patient Registration Form and take it on your visit. If your physician feels you need a sleep consultation or sleep study, he will fax it to us.

  • If you are a patient who is self-referring (contacting us directly), please make an appointment by either calling us or filling out the Patient Registration Form. Once an appointment is made, then the forms below will need to be printed, filled out and brought to your 1st appointment.

  • Patient Registration Form – First step towards a Better Sleep, Better Health, Better Life

  • Admissions Questionnaire (Spanish) – Health history so that we can determine the best course of action for you to a Better Sleep, Better Health, Better Life.

  • Patient Disclosures and Authorizations (Spanish) – Back office requirements to allow us to provide you with a Better Sleep, Better Health, Better Life.

  • Release of Medical Records (Spanish) – Fill this out under any of the 2 following circumstances:

1. If you want us to provide your medical records to someone other than your referring physician.

2. We may ask you to complete this form if we need to obtain more information about your medical history from another provider.

Please feel free to contact us at (512) 238-7777 if you have any questions

  • White Facebook Icon
  • White Instagram Icon
  • White LinkedIn Icon
  • White Google+ Icon
  • White YouTube Icon
  • White Vimeo Icon

GET IN TOUCH

info1@MyAdvancedSleepCenter.com

(512) 238-7777

NORTH LOCATION:

3600 W Parmer Ln ste 108, Austin TX 78727

SOUTH LOCATION:

5920 W. William Cannon Drive, Bldg. 6; Ste. 100, Austin, TX 78749
 

Copyright © 2019 My Advanced Sleep Center. All rights reserved.

  • White Facebook Icon
  • White Instagram Icon
  • White LinkedIn Icon
  • White Google+ Icon
  • White YouTube Icon
  • White Vimeo Icon