Thank you for selecting
Durbin Family Practice for your healthcare needs. We
strive to deliver comprehensive, high quality,
cost-effective care with a focus on the quality of the
Provider/Patient relationship and patient satisfaction.
To better serve you, we ask that you bring all of the
following items to your appointment:
• Completed paper work
• Any recent x-ray or MRI results related to your
condition
• Any recent tests related to your condition
• Driver's license
• List of all medications you are currently taking
• Insurance card
• Military ID (if applicable)
• Payment ( We accept American Express, Discover,
Mastercard and Visa).
Should you have any questions or
need to reschedule you appointment please call our
office at (817) 640-5412. Thank you again for choosing
Durbin Family Practice. We look forward to seeing you.
The following forms can be printed from your printer prior to
your visit. Completing these forms will save time
during your office visit.
Patient Information Sheet
Insurance Assignment & Release
Health History
Patient Record Of Disclosures
Notice Of Privacy Practices
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