Patient Forms

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We take most insurance plans, including Medicare and Medicaid. We are happy to provide care to the uninsured. Feel free to review the No Surprise Act Form for the cash option fee schedule.

Please download and complete the New Patient Packet for all patients wishing to establish care with Boerne Healthcare Group and who have commercial insurance or existing Medicare. Completion of these forms in entirety ensures the communication of vital health information so appropriate and safe treatment may be given. We would appreciate your arrival at the clinic 15 to 30 minutes before your appointment. If you have trouble printing the documents, please arrive 30 min before your appointment so we can provide you with the forms to complete. The new patient packet includes the following: 

1. Patient Registration Forms
2. Patient Financial Responsibility Statement form
3. Authorization to Release Medical Records form
4. Cancellation, No show, and Late arrival policy
5. Receipt of Privacy Notice (Review Privacy Notice available in Forms)
6. Designation for Release of Medical Information to a Family Member
7. No Surprise Act Form 

BiosanaID Hormone Pellet Therapy: If interested in receiving an evaluation for female or male hormone replacement therapy, please download and complete the appropriate packet and bring it with you to your scheduled appointment. Please call us with any questions. 

IMPORTANT: The No Surprise Act Form is mandated by the Federal Government. The purpose of this document is to be transparent about charges that may apply to you if you are out-of-network with your health insurance plan and informs you about your protection from unexpected medical bills. It also asks whether you would like to give up those protections and pay more for out-of-network care so the provider at Boerne Healthcare Group can see you. If you are uninsured, this document will let you know your estimated costs for care as a new or existing patient at a reduced rate. If out-of-network charges are billed, we will negotiate an adjustment to your bill, or you can pay the uninsured reduced rate by 50%.

If you are an existing BHG Medicare patient coming for your Medicare Annual Wellness Visit, please download and complete the following forms before your scheduled appointment: 

1. AWV - Health Assessment Form
2. Memory Loss ADL Assessment form

Boerne Healthcare Group is passionate about Advanced Care Planning (ACP) and has made available the Texas Medical Power of Attorney form, Advanced Directive to Physicians form, and the Out-of-Hospital Do Not Resuscitate form for downloading and completion at your convenience. A discussion regarding ACP with the provider is encouraged at any time but will be included on your initial visit. 

It is never too early to be prepared!

No insurance, no problem! We have a posted fee schedule as part of the NO SURPRISE ACT with listed fees for services with a 50% discount on standard charges. The No Surprise Act Form is part of the new patient registration packet. YOU DO NOT HAVE TO SIGN IT but by not signing it BHG may choose not to provide services and you can seek an in-network provider under your health insurance plan. 

IMPORTANT: In an effort to go paperless and remain HIPAA Compliant, please download the forms, fill in your information and bring the documents to the clinic 15 to 30 minutes ahead of your appointment so your chart can be created and the information can be . The datame. BHG is happy to provide the documents to you if necessary but with an added fee of $5, and you must arrive 30 min ,prior to your appointment tobeforee time to complete them. You can also fax your information to 210-519-3012 where your PHI will be rece,ived securely. We thank you for your patience and understanding.

Thank you, and Welcome to Boerne Healthcare Group!!! We look forward to seeing you!!