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Patients

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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
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New Patients Form

Simplify your registration process and ensure tailored care by completing our new patient form.

Download New Patient Form

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General Body UltraSound

Enhance your ultrasound with a seamless experience by filling out this form.

Download Ultrasound Form

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Mammography Questionaire

Streamline your mammogram experience by completing our questionnaire.

Download Questionaire

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Medical Release Form

Complete our medical release form for efficient and timely access to your records.

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

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