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Dr. Chuck Tillotson & Dr. Jan Nix

New Patient Forms


Like any doctor’s office, there is a bit of paperwork which we to have an accurate and complete medical history of before your first appointment.

You can download it here and fill it out in the comfort of your own home in your own time before your appointment.  It is very important that you be through in filing out this paperwork so that your condition can be better addressed by the doctor.  Even seemingly small details are important to both your care and your treatment plan.

View HIPPA Regulations

Download New Pediatric Patient Forms (newborn-12)

Download New Adult Insurance Patient Forms

Download New Adult Cash Patient Forms

Download New Auto Accident Patient Forms 

If you have any questions in the process of completing the forms, or if you have problems downloading and printing them, please call our office manager at (940) 382-6141 for assistance. We are in the office Monday through Thursday and our voicemail is on 24 hours per day, 7 days per week. We check voicemail regularly when we are out of the office and will get back to you as quickly as we can.

Thank you for taking the time to complete your paperwork before coming for your first appointment. It helps us have the time to give you the extra attention and service that you deserve. It also helps us stay on schedule which we know that you, we, and our other patients will all appreciate.



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