Patient Forms

Dr Nguyen looks forward to meeting you and discussing your goals. We strive to keep our appointments on time, as scheduled. Prior to your appointment, we kindly ask that you fill out the patient forms that are located below so that we can accelerate your check-in process. Please download, print and complete the forms and bring them with you to your appointment. If you are unable to download our patient forms, then it is recommended that you arrive to your appointment between 15-30 minutes early so that you can have ample time to fill out the appropriate forms.

**If your paperwork is not completed at the time of your appointment we will need to re-schedule your appointment.

New Patient Form

New Patient Form

New Patient Registration, Medical History, HIPPA Notice, and Patient Consent forms.

ASP Acknowledgement

ASP Acknowledgement

American Surgical Professionals

General Office Policies

General Office Policies

Office Policies

Photo Consent

Photo Consent

Photo Consent

Medical Release Form

Medical Release Form

2015 Medical Release Form

Privacy Practices

Privacy Practices

North Dallas Urogynecology

HIPAA Disclosure

HIPAA Disclosure

HIPPA Disclosure

*Individual results are not guaranteed and may vary from person to person. Images may contain models.