New Patient Forms and Insurance Information

For your convenience, our new patient form is available for you to download online. Please print out this form, complete it as thoroughly as possible, and send it to us via fax 1-888-321-3171 or email. This will expedite the start of patient care.

New Patient Form

Healthy Connections Works with the Following Insurance Companies:

  • Aetna
  • Aetna Medicaid
  • Blue Cross Blue Shield
  • Cigna
  • Great West
  • Molina
  • Pacificare
  • Private Healthcare System (PHCS)
  • Texas Childrens’ (CHiP)
  • Texas Childrens' Heathplan (STAR Medicaid)
  • Texas True Choice
  • United HealthCare

If you have any questions about treatment, please feel free to call us at 1-888-304-1800.