Making An Appointment

Complete your forms in advance. Please print forms, complete, and bring to your appointment.

• HS Medical History Form (New form needed every 3 years)
• Consent Form for Minors (under 18) (Parent/Guardian must sign)
• Consent Form for Minors (Emancipated Minor ONLY)
• HS Financial Policy (First visit only)
• HIPAA-Receipt Form (Sign after reading Notice of Privacy Practices)
• HIPAA-Notice of Privacy Practices-Short Version (No need to print)
• HIPAA-Notice of Privacy Practices-Long Version (No need to print)

Record Release Forms: If you would like a copy of your records from UT Arlington Health Services, please choose the appropriate form from the list below, print, complete, sign, and send it along with a copy of picture identification to UT Arlington Health Services.

Mail to: Arlington Health Services
Box 19329
Arlington, TX 76019

Fax to: 817-272-3829

• HS Records Release Form (To receive records of services performed at our facility)
• HS Records Release Form-Outside Entities (To send records to us from other health care facilities)
• HS Records Release Policy (Procedure and Cost for obtaining health records from UT Arlington Health Services)