Patient Information

We are currently accepting Aetna, Blue Cross Blue Shield PPO, and traditional Medicare.
We are NOT contracted with Cigna or BCBS HMO(Magellan). Dr Herzog is now accepting United Healthcare.

New patient appointments are for Evaluation and Medication Management, we do not schedule evaluations for FMLA, disability, Workers Compensation.

Please call and schedule your appointment before filling out forms

New Adult Patient Packet

To be completed before the first visit.

New Child Patient Packet

To be completed before the first visit.

IMPORTANT

  • These forms must be filled online and cannot be printed. When you arrive at your appointment, you can request a printed copy for your records.
  • Please avoid closing your browser window until the final submission of the patient's data at the end. If you accidentally close your browser window, then you can come to our office to complete the forms.

PHILOSOPHY OF TREATMENT

To review our philosophy of treatment

Request an Appointment

To request an appointment please fill out the form below or Call 972-709-1961.

Request a Appointment