New Patient Forms

Please print and complete the following forms prior to your initial clinic visit, and bring them with you on the day of your scheduled appointment.

Please read before completing forms: Notice of Privacy Practices

Patient Intake Form
HIPAA Authorization Form
Acknowledgement of Receipt of Notice of Privacy Practices

If you are unable to print your forms ahead of time, please arrive 15 minutes prior to your appointment to complete them.

Plan to provide your driver’s license and insurance card on the day of your appointment.

Insurance Information

We are contracted with most major insurance carriers in Texas, including but not limited to:

BCBS TX, United Healthcare, Cigna, Aetna, Humana, Kelsey-Seybold, Amerigroup, Texan Plus, ChoiceCare, Renaissance Physician Organization, Molina Healthcare, Community Health Choice, MultiPlan, Affiliated Healthcare, Methodist Care, Prime Health Services, and America’s Choice Provider Network.

Clinic Location

We are located in Suite 184 of the Medical Plaza 1 building of Memorial Hermann Memorial City. There are two convenient parking options:

  • Garage 3
  • Surface lots accessible by Kingsride

If you need to reschedule your appointment, please call 713-242-4046 to do so at least 24 hours in advance.

The new Memorial Hermann “Find My Way” app is now available as a free download in the App Store for IOS devices and Google Play for Android. The app serves as a navigation system to assist with wayfinding and parking at the Memorial Hermann Memorial City Medical Center.

After downloading the app, please enter one of our radiologists to begin navigation from your location to our clinic.