USMD Prostate Cancer Center | Arlington, Texas

USMD Prostate Cancer Center is happy to offer our patients the option to submit their patient forms online! Complete the forms below (también disponible en traducciones españolas) by filling them out using your computer! After completion, use the "Upload Link" below to submit your forms to our office!

Note: Using your computer to complete and submit forms to USMD Prostate Cancer Center, you must have Adobe Reader 9 (or later versions) installed on your computer. To install this free program, click HERE.

Download, complete and save the forms below somewhere on your computer:

Forms (English)	Formas (en Español)
Patient Information Form (click to download)	Hoja de la Información del Paciente (teclee aquí para descargar)
Patient History Form (click to download)	Historia de la Actual Enfermeadad (teclee aquí para descargar)
Financial Policy Form (click to download)	Póliza Financiera y Forma de Consentimiento del Paciente (teclee aquí para descargar)
HIPAA Disclosure & Privacy Authorization (click to download)	Aviso de HIPAA (teclee aquí para descargar)

Use the upload portal below to submit the forms that you saved to your computer.

You must include your Full Name, Email Address and Phone Number to send these forms. When complete, click the "SEND FORMS" button.	Find and attach your three completed forms using the fields below:

Having trouble sending your forms?
Just print them out and bring them with you to your appointment!

*Full Name
*Email Address
*Phone Number
*Street Address
*City	*State
	*Zip Code
*How do you prefer to be contacted?

*Where did you hear about us?

What comments or questions do you have?

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