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New patient forms

Please fill out all the below patient forms before coming to your clinic appointment at Cuero Medical Clinic, Parkside Family Clinic, Goliad Family Practice, Kenedy Family Practice or Yorktown Medical Clinic.

Also, please bring the following:

  • Driver’s license.
  • Health insurance card(s).
  • Medicare or Medicaid card(s).
  • Current shot record for minors.
  • Current medication list.

Thank you for choosing us for your healthcare needs.

Download new patient forms (pdf)

Consent to release medical infomation (pdf)

Authorization to treat minor (pdf)