Patient Information

Below is a list of the forms needed for your first visit to our office. Please print and bring each page to y our scheduled appointment. We have provided the HIPAA policy for your convenience.

PATIENT REGISTRATION
PATIENT HISTORY
HIPAA POLICY
HIPAA ACKNOWLEDGEMENT SIGNATURE PAGE

Also, please be sure to bring your Driver's License and Insurance Card to your visit, as we will need to make a copy for our files.

We will file any insurance that you may have. However, we have chosen not to be a provider for any specific network. If you choose to pay in full at the time of service, you will receive a discount: 5% discount with Visa, Mastercard, or Discover, or a 10% discount with a check or cash. We also accept CareCredit.

Office Information

Monday 8:00 a.m. - 5:00 p.m.
Tuesday 8:00 a.m. - 3:00 p.m.
Wednesday & Thursday 8:00 a.m. - 5:00 p.m.

2815 South Georgia • Amarillo, Texas 79109 • (p) 806.358.7646 • (f) 806.358.3064
© Copyright Steve Austin General Dentistry • elizabethliles