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Please be advised of COVID19 screening and safety precautions. All patients and visitors can use a facemask

3650 W. Wheatland Rd. Suite C, Dallas, TX 75237

Phone: 214-774-9771

Fax: 214-774-9762

Russell M. Canham

, MD, MCS

Patient Forms for New and Established Patients

Please bring ALL medication bottles and any medical records you have to ALL visits

Please bring insurance cards and ID

Filling Out a Medical Form

Doctor and Patient

New Patient Forms

New Patient Health Information and Medical Records Release Form

New Patient Appointment Notification Form

Protected Health Information and Privacy Practices Form

Established Patient Forms

Established Patient Clinical Update Form

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