On your first visit to Serenity Gynecology and Functional Medicine you will need to bring your
- Driver License/Photo ID
- Insurance Card(s)
- Co-pays, co-insurance and deductibles which are due at the time of service
For General Gynecology visits click the links below to print out your patient forms and have them completed at the time of your visit. If unable to fill them out at home please arrive 20 minutes early to complete. If not completed we may have the right to reschedule.. MEDICARE is not accepted at this time, but we do offer special pricing for self pay patients.
ALL APPOINTMENTS MUST BE CONFIRMED. Our office will contact you to confirm your appointment. Appointments not confirmed may be rescheduled by our office. Please respond with confirmation at least 24 hours prior to your appointment.
You have the option to print the forms and bring the completed forms to your appointment or you can scroll down to the ONLINE PATIENT FORMS below and click on each one of the three links and your information will be sent to our office securely electronically.
We do not require the Medical Records Release be completed unless we need to request records from another office.
When printing the Notice of Privacy Forms print only the signature page .
Print these forms and complete to bring to office:
- New Patient GYNECOLOGICAL CARE Form
- Financial Policy
- Authorization of Use and Disclosure of PHI [PDF]
Privacy Forms (Complete if you are needing records transferred only)
- Medical Records To Be Released From Our Office
- Medical Records To Be Released To Our Office
ONLINE PATIENT FORMS (Please click on each link to complete forms)
In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.
We are located at 220 N. Park Blvd #100 Grapevine TX 76051
Office Hours: Monday-Thursday 9:00AM-5:00PM Friday 9:00AM-1:00PM
Office: (817) 280-9616
Fax: (817) 722-6328
For More Information or To Make An Appointment Please Fill Out The Form Below And Someone From Our Office Will Call You