Ochna Health Patient Forms
- For our New Patients
- For faster service, please pre-register online at Individual Patient Registration
- Please pre-complete the New Patient Medical History Form (English) prior to the visit.
- El Formulario de Historial Médico para Pacientes Nuevos también está disponible en español.
- The New Patient Medical History Form includes the Membership Agreement (for DPC Members), as well as the Third-Party Communication Authorization and Record Request Authorization forms below.
- Privacy Form
- Third-Party Communication Authorization: Allow us to communicate with someone other than you about your medical conditions.
- Medical Records Forms
- Record Request Authorization: Allow us to request your medical records from your other physicians, health care providers, or facilities.
- Record Release Authorization: Request us to release your medical records to other physicians, health care providers, or facilities.
- Do you have records in PDF? Securely Upload Medical Records to us.
Clinical Forms and Questionnaires
- Well Child Forms
- Dear Parents, Please complete the Well Child Questionnaires prior to the visit. Thank you.
- Clinical Questionnaires
- COVID-19 Screening Questionnaire
- Asthma: Asthma Control Test
- Sleep Apnea: Epworth Sleepiness Score for Sleep Apnea Risk
- Depression: Screening and Follow up with the Patient Health Questionnaires
- Postpartum Screening: Edinburgh Postnatal Depression Scale (EPDS)
- Enlarged Prostate: AUA BPH Symptom Score
- AUA: American Urological Assocation
- BPH: Benign Prostate Hyperplasia
- Consent Forms
InstaMed Secure Payment Portal
For our Patients using Insurance
You can make your payment on our InstaMed Secure Payment Portal
For Patient ID/Account Number: Please use your initials
Thank you for choosing our clinic.
Educational and Media Resources
- Cholesterol and Heart Disease
- 10-year Heart Risk Calculation (need cholesterol and blood pressure readings)
- Educational Pictorials from the American Heart Association (AHA)
- Great Cholesterol Information from the National Institute of Health (NIH)
- Mediterranean Diet is best of heart health
- Blood Pressure
- Great Information about Blood Pressure from the NIH
- Cancer Risk Assessment
- Breast Cancer Risk Assessment Tool from NIH
- Prostate Cancer Risk Assessment Questionnaire from UT Health San Antonio
- Colorectal Cancer Risk Assessment Tool from National Cancer Institute
- Colorectal Cancer Screening Options
- Pediatric Topics
- Positive Parenting Solutions
- Healthy Children from the Academy of Pediatrics
- Development Milestones Checklist from the CDC
- General Health
- Do you need that antibiotic, or that test? Making Health Choices is worth a read.
- Ergonomic Setup information from UCLA
- Back pain: Manual using Yoga to treat back pain from Mayo Clinic
- Mayo Clinic Disease Database
- Look up calorie contents of common foods via fatsecret.com
- Research the Herbs and Supplements Database by the US National Library of Medicine
- Browse the Natural Medicines Comprehensive Database ® courtesy of Kaiser Permanente
- Drugs and Natural Medicines Interaction Checker courtesy of Kaiser Permanente
- Benign Vertigo Maneuvers (on YouTube by ENT specialist Dr. Chang)
Community Health Resources
- Vaccinations for Children:
- Williamson County: Eligible to receive childhood vaccinations at Williamson County Health Department Clinics if Uninsured, or Underinsured (insurance does not cover vaccines)
- Travis County: City of Austin program
- Children: $14 per dose of vaccine. Shot Records: $5. No one is refused services if they are unable to pay.
- Vaccinations for Adults
- Williamson County: Eligible to receive vaccinations at Williamson County Health Department Clinics if Uninsured
- Hepatitis A/B, MMR, Tdap or Td, Pneumococcal, Meningococcal, Varicella, HPV, Zostavax Shingles vaccine (ShingRix vaccine not yet available)
- Cost is $25 per vaccine
- Travis County: City of Austin program
- Adults: $25 per dose of vaccine. Shot Records: $5. No one is refused services if they are unable to pay.
- Affordable Colonoscopy: Colonoscopy Assist Program
- Medicaid for Breast and Cervical Cancer from Texas Department of Health and Human Services
- Dental Care
- Mental Health Resources