Patient Forms
New Patient Forms
(all forms can be printed, emailed, or attached to your patient portal prior to arrival. If you need further assistance, please call the office or complete in person.)
Electronic Forms
(all forms can be printed, emailed, or attached to your patient portal prior to arrival. If you need further assistance, please call the office or complete in person.)
- Disclosure and Consent of Influenza Vaccine
- Immunization Questionnaire
- Disclosure and Consent of Tuberculosis Test
- Disclosure and Consent of In-Office “Surgical” Procedures
- Disclosure and Consent of Vaccination
- Medical Record Release FROM Adjuva Primary Care
- Medical Record Release TO Adjuva Primary Care
***There is a 24-hour cancellation policy with Adjuva Primary Care. We understand that things come up and if you can not make your appointment, please notify the office 24-hours prior to your appointment, if you do not cancel and do not show up for your appointment, there will be a $50 no show fee applied to your account.
Adjuva Primary Care
Primary Medical Care, Hormone Replacement Therapy, Allergy Immunotherapy, & Dermal Aesthetics
Email Address
Call Us
Visit Me
Northlake Texas, 76262-1466
Adult Primary Care Services in Northlake, TX:
Justin • Elizabethtown • Keller • Rhome • Argyle • Roanoke • Trophy Club • Corral City • Westlake • Southlake • Haslet • Grapevine • Colleyville • Watauga