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Mission East Dallas
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Patient Forms

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Patient Forms
Patient Consent Acknowledgement
Privacy Policies
Adult Health History Form
Pediatric Health History Form
Consent for Minors Policy
Other Acknowledgements
Formulario de Registro del Paciente
Iniciales De Paciente
Aviso De Practicas De Privacidad
Historia Clinica Para Adultos
Historia Clinica Pediatrica
Otros Reconocimientos
Consentimiento para la poliza de Menores

Sliding Fee Scale

Sliding Fee Scale Information
Sliding Fee Scale Application
El plan de descuento información
Aplicacion para el plan de descuento
If you are experiencing an emergency, please dial 9-1-1 immediately. If you are a Mission East Dallas (MED) patient and need to reach us after hours for a non-emergency medical or dental problem, please call 972.682.8917 and an after-hours nurse triage service can assist you with your concerns.