For More Information or To Make An Appointment Please Fill Out The Form Below And Someone From Our Office Will Call You
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.
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.
- New Patient GYNECOLOGICAL CARE Forms
- Financial Policy
- Authorization of Use and Disclosure of PHI [PDF]
- 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 all 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