Patient Resources & 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)
- Outpatient Therapy Prescription (PDF)
- Speech Language Pathology Prescription (PDF)
- Modified Barium Swallow Study Referral (PDF)
- Child Case History - Speech Therapy (PDF)
To mail a payment:
CHI 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.
Health Information for the whole family.
Up To Date
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