Appointment Request

Please fill out our simple appointment request form. Someone from our staff will confirm a specific appointment time with you based on your preferences and our appointment availability. NOTE: Your requested time may not be available.

Things you should bring to your appointment

‚Äč

  • Insurance card    

  • An unexpired government issued ID for patients age 18 years and older

  • Current list of medication you are taking 

  • Shot records for children requiring vaccination

FOR NEW PATIENTS, PLEASE DOWNLOAD THE FORMS BELOW AND FILL OUT.

NOTE: After filling the forms, you can either print and bring it along with you to our office location or email the saved copy to us through info@medexquickcare.com … You can also fax the form(s) to: 972-787 - 0172

 

Click on the link below to download form

Patient Information Form

Medical History Forms

Medication List Form

© 2017 MedEx Quick Care  All Rights Reserved

408 West Camp Wisdom Road Duncanville, Texas 75116

Tel: 972-787-0070

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