ABOUT OC OC DOCTORS PATIENTS & VISITORS CLINICAL TRIALS MEDICAL PROFESSIONALS OC NEWS LOCATIONS

New Patient Registration
 
New Patient AppointmentsNew Patient Registration
 
New Patient Registration
     
 

Medical Center (Cancer Center)
2130 W. Holcombe Blvd., 10th Floor
Houston, TX 77030
Ph (713) 600-0900
Fax (713) 600-0070

Memorial City
925 Gessner, Ste. 600
Houston, Texas 77024
Ph (713) 827-9525
Fax (713) 468-3561

Sugar Land
16675 Southwest Fwy., Ste. 250
Sugar Land, Texas 77479
Ph (281) 491-5511
Fax (281) 491-5513

Katy
Katy New Location
18400 Katy Fwy., Suite 670
Houston, TX 77094
Ph (281) 578-0201
Fax (281) 578-0217

Willowbrook
18220 Tomball Pkwy., Ste. 240
Houston, Texas 77070
Ph (281) 477-8600
Fax (281) 477-8577

Southwest
7737 Southwest Fwy., Ste. 575
Houston, TX 77074
Ph (713) 778-0300
Fax (713) 778-0303

Northwest
1631 North Loop West, Ste. 155
Houston, TX 77008
Ph (713) 802-9000
Fax (713) 802-2701

Radiation Therapy Center
Houston Precision Cancer Center
10405 Katy Freeway, Suite 150E
Houston, TX 77024
Ph (713) 722-9660
Fax (713) 722-9664
 

Print and complete the forms below prior to coming for your appointment. Bring these forms along with your id and insurance cards with you on the first day. This will decrease your waiting time. If you cannot complete these forms, then arrive 30 minutes before your scheduled appointment.

Printable Forms
Financial Policy
Authorization to Use and Disclose PHI
Consent to Use and Disclosure of Information

Notice of Privacy and Information Practices
Preferred Physician:  
Preferred Location:

Patient Information
Patient's Last Name: Patient's First Name: MI:
Sex: Marital Satus:  
 
Date of Birth:
/ /
Address:      
City: State: Zip:
Social Security #:  
Email Address:  
Home Phone:  
Cell Phone:  
Patient Employer: Employment Type: Work Phone:

Emergency Contact
Contact Name: Contact Phone: Relationship:
Address:      
City: State: Zip:

Primary Insurance
Insurance Company: Insurance Phone:  
 
Insured Name: Social Security #: Relationship:
Insured Employer: Employer Phone:  
 
Employment Type: Prescription Benefits:  
 
Insurance Type: Referral Needed:  
 
Insured Date of Birth:
/ /
Group Number: Policy #:  
 

Secondary Insurance
Insurance Company: Insurance Phone:  
 
Insured Name: Social Security #: Relationship:
Insured Employer: Employer Phone:  
 
Employment Type: Prescription Benefits:  
 
Insurance Type: Referral Needed:  
 
Insured Date of Birth:
/ /
Group Number: Policy #:  
 

Prescription Benefits
Prescription Insurance Name: Bin #:  
 
PCN/Processor #: ID #:  
 
Group #:    
   

Health Care Providers
Referring Physician: Phone:  
 
Primary Care Physician: Phone:  
 
Reason for Referral / Diagnosis: