Patient Forms

For your convenience we have provided the following patient forms on our website. These forms can be completed online
or downloaded directly to your device for printing.
In addition, patient forms can be collected in person
at our Waxahachie or Ennis location.

Please complete each form in its entirety to prevent delays in processing. If you need assistance, you may contact us directly at 972-923-2440 and a staff member will be happy to assist you.

PATIENT REGISTRATION

Hope Health welcomes new patients daily. The first step to becoming a Hope Health patient is to complete the necessary registration forms. Please click on the link below to be directed to the registration page.

MEDICAL RECORD
REQUEST FORM

You can obtain a copy of your medical records or have your medical records released by completing the online Medical Records Release Form or downloading the printable form and submitting it one of the following ways. Please allow 7-10 business days for processing:

  • Scan or email to info@hopehealthtx.org

  • Fax to 972-923-2445

  • In person at either location (Waxahachie or Ennis)

ONLINE MEDICAL RECORD REQUEST FORM:

PRINTABLE MEDICAL RECORD REQUEST FORM:

 

VACCINE INFORMATION FORMS

Below is a list of forms giving additional information about
vaccines commonly administered at Hope Health.