ONLINE REGISTRATION FOR HECTOR L. FRANCO, M.D.
| 915-598-1959 |
| DERMATOLOGY |
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ATTENTION NEW OR UNESTABLISHED PATIENTS:
PLEASE DOWNLOAD THE ONLINE REGISTRATION PACKET ON THIS
SITE. THIS WILL ALLOW US TO GIVE YOU THE EARLIEST AVAILABLE
APPOINTMENT. THE NECESSARY PAGES CAN BE ACCESSED BY
CLICKING THE NAVIGATION BUTTONS AT LEFT. THEY INCLUDE:
1. MEDICAL HISTORY
2. INSURANCE
3. CONSENT FORM
4. HIPPA NOTIFICATION
5. COSMETIC INFO (optional)
BY COMPLETING THESE FORMS PRIOR TO YOUR VISIT YOU WILL
HELP US MAKE YOUR OFFICE EXPERIENCE MORE EFFICIENT.
ON THE DAY OF YOUR APPOINTMENT PLEASE BRING WITH YOU A
COMPLETED REGISTRATION FORM, PROOF OF INSURANCE, A
REFERRAL FORM IF YOU ARE AN HMO PATIENT AND ALL CURRENT
MEDICATIONS. THANK YOU.
HECTOR L. FRANCO, M.D.
PLEASE DOWNLOAD THE ONLINE REGISTRATION PACKET ON THIS
SITE. THIS WILL ALLOW US TO GIVE YOU THE EARLIEST AVAILABLE
APPOINTMENT. THE NECESSARY PAGES CAN BE ACCESSED BY
CLICKING THE NAVIGATION BUTTONS AT LEFT. THEY INCLUDE:
1. MEDICAL HISTORY
2. INSURANCE
3. CONSENT FORM
4. HIPPA NOTIFICATION
5. COSMETIC INFO (optional)
BY COMPLETING THESE FORMS PRIOR TO YOUR VISIT YOU WILL
HELP US MAKE YOUR OFFICE EXPERIENCE MORE EFFICIENT.
ON THE DAY OF YOUR APPOINTMENT PLEASE BRING WITH YOU A
COMPLETED REGISTRATION FORM, PROOF OF INSURANCE, A
REFERRAL FORM IF YOU ARE AN HMO PATIENT AND ALL CURRENT
MEDICATIONS. THANK YOU.
HECTOR L. FRANCO, M.D.