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Patient Forms

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Most of our forms can be downloaded and read using Adobe Reader. If you do not have Adobe Acrobat Reader, download here.

ADULT HISTORY FORM

Please download this form and complete it prior to your visit at MacGregor, along with the attached HIPAA Acknowledgment Form and the Financial Acknowledgement Form, if you are 18 years old or older and a new patient. If you have not been to see us in over 3 years, you will be a new patient.

CHILDREN: AUTHORIZATION FOR MEDICAL TREATMENT OF MINORS

If your child needs to be seen by a physician, but you or the other parent is not able to accompany the child, then you need to give written authorization for the child to be seen and treated. Please download, complete and send this with your child’s caregiver.

CHILDREN: PEDIATRIC HISTORY FORM

Please download this form if you are bringing your child in to see one of our physicians for the first time. You can complete the history at home, then bring it with you.

DIRECTIVE TO PHYSICIANS (LIVING WILL)

Completing a Directive to Physicians allows your physician and your family to know what you would want them to do in a case where you could not make your own decisions about your health care.

DO-NOT-RESUSCITATE ORDERS

The Texas Department of State Health Services provides a standard “Do Not Resuscitate” order form that you can sign requesting that no CPR or certain other emergency treatments be done. It also allows guardians and parents to make those decisions in appropriate situations.

DURABLE POWER OF ATTORNEY FOR HEALTH CARE

f you should become unable to make decisions about your health care, having this document would allow others you trust to make those decisions for you, such as your spouse, your parent, your child, your sibling or a friend. This is important if you have an accident, or develop dementia, or have a sudden debilitating illness.

FINANCIAL ACKNOWLEDGEMENT FORM

You will be requested to sign this form on your first visit to MacGregor.

HIPAA ACKNOWLEDGEMENT FORM

The Health Insurance Portability and Accountability Act (HIPAA) requires us to provide you with the opportunity to review your rights under this act, and then to acknowledge you have had this opportunity. This is the form to say that you’ve had the opportunity to look at it. We are required to ask you to sign this form by the HIPAA regulations. You may print out just the last page if you do not wish to print the entire notice.

INSURANCE INFORMATION

Please complete Part 2 of this form before your first visit, or if your health insurance changes, so that we can more quickly get you through the check-in process.

MEDICAL RECORDS RELEASE FORM - OUTGOING

Use this form to request that we send your MacGregor records to someone else. There may be a charge associated with copying records for you, but we generally do not charge for sending records to other health providers.ation for the child to be seen and treated. Please download, complete and send this with your child’s caregiver.

MEDICAL RECORDS RELEASE FORM - INCOMING

This form allows you to request that medical information from other physicians or hospitals be sent to us. Download it, complete it, and mail it off – you may wish to make a copy for your records before mailing.

MEDICAL RECORDS: RESTRICT RELEASE OF RECORDS

You may request that information not be released about you to specified individuals or entities.

MEDICARE WELLNESS EXAMS ("PHYSICALS")

Medicare Wellness Exams and Welcome to Medicare Exams need a little explanation.

PHYSICALS (WELLNESS EXAMS)

What do you expect in a physical?

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9969 Fredricksburg Road
San Antonio, TX 78240

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