NEW PATIENT FORM
    NEW PATIENT
    English
    online  /  download


    Spanish
    online  /  download

    MEDICAL HISTORY

    English
    online
      /  download

    Spanish
    online  /  download

    NEW PATIENT FORM
    HIPAA FORM

    English
    online
      /  download

    Spanish
    online  /  download

    CONSENT TO TREAT

    English
    online  /  download

    Spanish
    online  /  download

    Patient Check-In Forms

    Our goal is to better serve you and improve your health! By completing the check-in forms ahead of time, you’ll save time in your appointment AND allow us to have the most accurate information. Please choose from one of the two options below and follow the instructions:

    [ Please advise as to the most efficient procedures based on your office – fairly complex instructions right now ]

    1. EASIEST METHOD - ONLINE:

    Complete & Send Online (Valid email Required)

    Steps:

    1)  Launch the respective form by clicking ‘online’ under the Form tab at top of page,

    2)  Complete electronically on your computer and follow the prompts,

    3)  Check your email to approve and send to DECCT.

    2. ALTERNATE METHOD:

    Download, Complete the Form, Scan/Save & Upload

    Steps:

    1)  Download the forms by clicking ‘download’ under the Form tab below,

    2)  Print out and complete form,

    3)  Scan, save to your computer, and upload with the tool below.

    ALTERNATE METHOD:

    Adobe Acrobat Reader Required

    Download / Complete / Upload,  or Bring With You

    Step 1: Download,  print out, complete by hand,

    Step 2: Scan to a PDF file, save to your computer, upload using the tool below

    NEW PATIENT FORM
    NEW PATIENT
    English
    download

    Spanish
    download

    NEW PATIENT FORM
    MEDICAL HISTORY

    English
    download

    Spanish
    download

    NEW PATIENT FORM
    HIPAA FORM

    English
    download

    Spanish
    download

    NEW PATIENT FORM
    CONSENT TO TREAT

    English
    download

    Spanish
    download

    Patient Check-In Upload Tool

    All patient information will be uploaded in an encrypted data format for security and confidentiality purposes. You may use this upload tool AFTER: 1) You have downloaded/completed on your computer and saved to pdf format OR, 2) You downloaded, printed and completed the Patient Check-In forms by hand and scanned the handwritten forms into a pdf format.
    • MM slash DD slash YYYY
      mm/dd/yyyy
    • Drop files here or
      Accepted file types: pdf, doc, Max. file size: 10 MB, Max. files: 5.
        .pdf, .doc, .txt files accepted

      SENDING & REQUESTING INFORMATION

      In a doctor/patient relationship, there may be more information that we need to obtain. Click on this resource list to send us Outside Lab Results, Imaging from other Providers, Medical Records from other Providers, or your personal blood sugar logs. Files must be in PDF, .doc, or .txt file formats.

      Trusted by Patients

      Dr. Carlos Arauz Pacheco, MD

      Learn More About Dr. Arauz-Pacheco's Biography, Specialities, and Certifications

      Dr. Carlos Arauz-Pacheco, MD is an Endocrinologist who has practiced in the Dallas area since 1994. He has expertise in several areas such as Diabetes Mellitus, Type 1 and Type 2, Hyperlipidemia, Obesity, diseases of the Thyroid Gland, Adrenal Glands and Pituitary Gland, Polycystic Ovary Syndrome, Parathyroid Disease, and Osteoporosis. He has ample experience in the management of Insulin Pumps, Thyroid Ultrasound, Thyroid Biopsies, among others.

      Dr. Dan Lender, MD

      Learn More About Dr. Lender's Biography, Specialities, and Certifications

      Dr. Dan Lender, MD is a Endocrinology, Diabetes & Metabolism Specialist in Rockwall, Texas with over 35 years of experience in the medical field.

      Learn More About Carlos Arauz's Biography, Specialities, and Certifications

      Carlos has worked as a physician intern in endocrinology and internal medicine, surgery, pediatrics, obstetrics & gynecology, and family/community medicine at the various public hospitals throughout Costa Rica as well as at Hennepin County Medical Center in Minnesota.

      Learn More About Pauline Pagel's Biography, Specialities, and Certifications

      Polly has been a Registered Nurse for 30 years with experience in Emergency Room Nursing and Intensive Care Nursing at Parkland Hospital in Dallas.

      Dallas

      12606 Greenville Ave, #215
      Dallas TX 75243

      Hours: Mon-Thu 8:00 am-5:00 pm
      Fri: 8:00 am-Noon

      (214) 660-2020
      (214) 660-2017 fax

      Rockwall

      890 Rockwall Pkwy, #102
      Rockwall TX 75032

      Hours: Mon-Thu 8:00 am-5:00 pm
      Fri: 8:00 am-noon

      (972) 475-5600
      (972) 475-5668 fax

       

      info@diabetesendotx.com