203 Sandy Corner
El Campo, TX 77437
Tel: 979.543.9933

Forms/Patient Services

Please download and complete the following form prior to your visit:  

>Intake Form
>Office Policies
>Notice of Privacy Practices
>Authorization for Release of Medical Records

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New patients and patients who have not seen our office within a year are asked to download the Intake Form for completion prior to the scheduled appointment. Once completed, please return via fax to 979-543-9959 or email to This email address is being protected from spambots. You need JavaScript enabled to view it. . If you are unable to complete and return these forms prior to your visit, please make arrangements to arrive 20 minutes ahead of your appointment time to complete the necessary paperwork.

You are required to bring identification (driver’s license) and a current copy of your insurance card to every appointment unless you do not have medical insurance coverage.

Minors: A parent or guardian must be present for the first patient visit. On subsequent visits, a consent form may be signed giving permission for the minor to be seen for follow-up appointments.

>Click here to download our Office Policies

You may schedule an appointment by calling our friendly staff at (979)543-9933. Our office hours are 8am-5pm, Monday – Thursday and 8am – 12pm on Friday. Please have the following information ready when you schedule an appointment:

1.Patient name

2.Date of birth

3.Patient phone number to contact about appointments/results

4.Reason for visit

5.Referring Physician (if the medical insurance is an HMO)

6.Insurance Plan

If you have an HMO or Health Select plan and require a referral, it is your responsibility to obtain the referral and ensure our office has this referral prior to your appointment.

If you discover that you need to reschedule your appointment, please notify us at least 24 hours prior to your appointment time. If you are scheduled for a procedure, please notify us 48 hours in advance if at all possible.

Thank you for your interest in our office. We look forward to meeting you!

The Staff of Dr. Melissa Kainer Erwin