To schedule your appointment, check the box below.
If we are unable to accommodate the above request, our scheduler will assign you to the next available appointment with the provider you have requested.
Texas law requires the Texas Department of State Health Services to collect information on the race/ethnic backgrounds of patients. Medical facilities are required to ask patients to identify their own race and ethnic backgrounds.
The data obtained through this process will be used to assist researchers in determining whether or not all citizens of Texas are receiving access to adequate health care.
You are NOT REQUIRED to answer the following questions. You may mark the choice that you are declining to answer.