Patient Resources and Forms

New Patient Forms

• Patient Registration Form in English (PDF)
• Patient Registration Forms in Spanish (PDF)
• Medical Record Release Form in English (PDF)
• Medical Record Release Form in Spanish (PDF)
• Medical History Long Form in English (PDF)
• Medical History Long Form in Spanish (PDF)
• Medical History Short Form in English (PDF)
• Pediatric Medical Release Form in English (PDF)
• Patient Notification of Data Collection in English (PDF)
• Registration Packet English Medicare

New Patient Forms-Pediatrics

• New Patient Forms- Pediatrics Newborn to 5 yrs. old in English (PDF)
• New Patient Forms- Pediatrics Newborn to 5 yrs. in Spanish (PDF)
• New Patient Forms- Pediatrics 6 yrs. to 17 yrs. old in English (PDF)
• New Patient Forms- Pediatrics 6 yrs. to 17 yrs. in Spanish (PDF)

Outpatient Forms

• Outpatient Therapy Prescription (PDF)
• Speech Language Pathology Prescription (PDF)
• Modified Barium Swallow Study Referral (PDF)
• Child Case History - Speech Therapy (PDF)

Billing Information

To mail a payment:
St. Joseph Health Regional Hospital
P.O. Box 202536
Dallas, TX 75320

If you would like to make a payment by phone, please call 1.888.275.9403.

Helpful Resources

Cost Estimator
We want to empower you with valuable information to help you and your family make important healthcare decisions. With this tool, you'll be able to find the general price estimate of the procedure you plan to have. Keep in mind that procedure costs can vary and do not include costs charged by others outside the hospital who are involved in a patient’s procedure, such as physicians, radiologists, and anesthesiologists. 

Family Doctor
Health Information for the whole family.

Up To Date
UpToDate is the largest clinical community in the world dedicated to synthesizing knowledge for clinicians and patients. UpToDate is an electronic information resource available via the web and mobile devices. You can get specific, detailed answers to your clinical questions.

Healthy Children
HealthyChildren.org is the only parenting Web site backed by 60,000 pediatricians committed to the attainment of optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults.