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Forms

You must have an appointment to be evaluated by a provider at Health Services. Appointments can be scheduled online, over the phone or in person. If you need to cancel or reschedule an appointment, please provide four hours advance notice, otherwise a no-show/missed appointment charge will be assessed to your account.

New Patient Forms

Please complete the New Patient Packet prior to your appointment by accessing the Health Services web portal, https://mavcare.uta.edu, and clicking on the Forms link.

Or you can print the packet, complete, and bring to your appointment.

Medical Release Forms

Authorization for Use and Disclosure of Protected Health Information (for requesting medical records for yourself)

Authorization for Use and Disclosure of Protected Health Information to Outside Entity (for requesting medical records  to release to someone else. e.g. doctor)

Your Rights and Responsibilities

Patient Rights and Responsibilities

Your Privacy

Health Services follows applicable State Medical Privacy Laws, including:

• Occupations Code Chapter 159

• Health & Safety Code Chapter 611

For questions regarding your medical records please contact the Administration Office at 817-272-2771.