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Rio Grande Medicine

Rio Grande Medicine

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Patient Forms

Rio Grande Medicine

Please click on one of the links below to open and view a form:

  • New Patient Registration
  • New Patient Registration (Español)
  • Authorization To Release Medical Records
  • Authorization To Release Medical Records (Español
  • Patient Consent To Treatment
  • Notice Concerning Complaints
  • Reportable Conditions In Texas
  • Financial Policy
  • PPO-HMO Network Insurance
  • Medical Records
  • Acknowledgement And Review Of Notice Of Privacy Practices
  • Patient Record of Disclosure
  • Notice of Privacy Practices Rio Grande Medicine

These forms are in PDF format (.pdf). Please download and install the latest
version of Adobe Reader if you cannot open the files.

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Hours of Operation | Scheduling Appointments
Front Desk: 956-421-2757 (8:00 am to 5:00 pm)

Rio Grande Medicine

Serving the Rio Grande Valley.

5505 S. Expressway 77/83, Suite 205
      Harlingen, TX 78550
956-421-2757
riograndemedicine.com

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