Forms

Please fill out these forms before your first appointment to save you time at the office. Please turn it in physically to the office or fax it to us at 866-218-2173.  To release records from Faith Community Health System (e.g. Jacksboro, TX), please return the medical release form to that office.  The fax number for Dr. Agarwal's Mineral Wells office is 866-218-2173.

Release of your medical records from a doctor's office or other entity to Global Family Practice, pLLC:

Release of your medical records to any entity (blank form):

Notice of Privacy Practices:

Telemedicine Consent:

Notice of Patient's Rights and Responsibilities:

Assignment of Benefits Form: