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Patient Information


Patient Forms

Thank you for choosing Asad Islam, M.D. For your convenience, we have provided the following patient forms for you to print and complete before your office visit.

1 Office Policy

2 Patient Registration Form

3  Payment Assignment from Your Insurance Carrier

4 Consent  for Treatment

5 Consent for treatment with Psychoactive Medications

6 Acknowledgement receipt of privacy practices


Our Notice of Privacy Practices describes how medical information about you may be used and disclosed, and how you can get access to this information. It is given to all new patients and a copy is available upon request.

What to Bring to Your Appointment

New patients are required to check-in 20 minutes prior to your scheduled time. Please bring the following with you to your first appointment:

  • Insurance Card(s) – if applicable
  • Photo ID
  • Co-pay/Co-insurance/Deductible/Balance is due in full at the time of service.

Appointments and Cancellations

If you cannot keep your appointment, please call 469-444-2244 to cancel or reschedule your appointment at least 24 hours in advance on a business day. When an appointment is missed, another patient that needed to be seen may have been unable to do so because that time slot was already taken. We do understand that emergencies occur and will work with you on an individual basis should such occur.

Insurance and Payment Information

We accept Medicare and most major insurance plans, please contact our office to find out if we accept yours. We accept Visa, MasterCard, Checks or Cash (please bring exact change as our office does not carry any change).


For questions regarding our patient information forms or policies,
please contact our office at 469-444-2244.