Patients

Patient Forms

To expedite the check in process on the day of your appointment, please fill out the paperwork that corresponds to the exams you will be having and bring them in on the day fo your appointment. If your appointment is for a Diagnostic Mammogram and/or Breast Ultrasound, or Biopsy and your most recent mammogram was performed at another hospital or facility, those films will be needed during your appointment for comparison purposes.
Please make arrangements to have a CD of your prior images sent to our office ahead of time.
For any questions, please call (817)-329-8910

Download New Patient Form

Download Ultrasound Form

Download Questionaire

Download Release Form

We accept all major insurances!

Our cash rates closely match our contracted rates with insurance, making it affordable if paying out of pocket. Contact us to discuss your options!

AETNA
AMBETTER
AMERIVANTAGE
BLUE CROSS BLUE SHEILD
BEECH STREET
CARE N CARE
CHILDREN’S MEDICAL
CHOICECARE
CHAMPVA
CIGNA
COOK CHILDREN
COVENTRY HEALTH
EHIM
FRESENIUS
FREEDOM LIFE INS

GALAXY HEALTHCARE
GEHA GPA
HEALTH SMART
HEALTH SPRING
HMO BLUE TEXAS
HUMANA
INDEPENDENT MED
INTEGRATED
LONESTAR INJURY LIBERTY HEALTHSHARE
LIBERTY HEALTHSHARE
MEDICARE
MEDICAID
MEDI SHARE
MOLINA

MULTIPLAN MUTUAL OF OMAHA
NATIONAL PREFERRED
NEXCALIBER
OSCAR
PHCS
PHILADELPHIA AMERICA
PRIME HEALTH SERVICES
PRIVATE HEALTHCAE
PROVIDER SELCT
PRIME HEALTH
ROCKPORT COMMUNITY
BAYLOR SCOTT & WHITE
SOUTHWEST LIFE
STONE MOUNTAIN

SUPERIOR
TEXAS PLUS
TEXAS BLUEBONNET
TEXAS HEALTHCARE
THE MIERS GROUP
THE TENY COMPANY
THREE RIVER
TRICARE
TXCIN CARE
UMR
UNITEAD HEALTHCARE
USA MANAGED
WEB TPA
WELLCARE
WELL POINT

If you don't see your insurance listed, please reach out to us, and we'll contact your insurance provider to provide you with all the necessary details.

No Insurance?

Our cash rates are close to our contracted rates with insurances, so you can easily afford this out of pocket cost. Contact us to discuss your options!

Breast Imaging Services	Note	Cash Price
3D Screening Mammogram	Saturday Only	$125
3D Screening Mammogram	Weekdays	$175
Screening Breast Ultrasound		$295

3D Diagnostic Mammogram	Unilateral	$225
3D Diagnostic Mammogram	Bilateral	$295
Diagnostic Breast Ultrasound	Unilateral	$225
Diagnostic Breast Ultrasound	Bilateral	$295
3D Diagnostic Mammogram (Unilateral) + Ultrasound (Unilateral)	Unilateral	$450
3D Diagnostic Mammogram (Bilateral) + Ultrasound (Bilateral)	Bilateral	$590
3D Diagnostic Mammogram (Unilateral) + Breast Ultrasound (Bilateral)		$520

Ultrasound Guided Biopsy	Per Site	$950
Ultrasound Breast Cyst Aspiration	Additional Cyst $50 each	$495
Breast Ductogram	Per Site	$395

General Ultrasound Services	Note	Cash Price
Ultrasound Abdomen	Limited	$275
Ultrasound Abdomen	Complete	$325
Ultrasound Pelvis	W/O Transvaginal	$275
Ultrasound Pelvis	With Transvaginal	$325
Ultrasound Thyroid	Renal or Soft Tissue	$325
Ultrasound Venous Doppler	Unilateral	$325
Ultrasound Venous Doppler	Bilateral	$425

Patients

Patient Forms

New Patients Form

Download New Patient Form

General Body UltraSound

Download Ultrasound Form

Mammography Questionaire

Download Questionaire

Medical Release Form

Download Release Form

We accept all major insurances!

No Insurance?