We accept most health insurance plans. Contact us at 972-439-3753 to confirm that we accept your policy and to schedule an appointment.

Patient Forms

To save time during your first visit with us download and print the documents listed under "New Patient Information". Bring them completed with you to your appointment, as well as your picture I.D. and insurance card.

New Patient Information

Patient Information
Patient Information Form.pdf
Adobe Acrobat document [5.1 MB]
Financial and Privacy Policy
Financial and Privacy Policy.pdf
Adobe Acrobat document [1.7 MB]
Medical History Questionnaire
Medical History Questionnaire.pdf
Adobe Acrobat document [376.9 KB]
Surgery Cancellation Policy
Surgery Cancellation Policy.pdf
Adobe Acrobat document [507.0 KB]

Other Resources

Notice of Privacy Practices
ASNTX Privacy Policy_v2.pdf
Adobe Acrobat document [237.3 KB]
Medical Records Release
Medical Records Release to ASNTX.pdf
Adobe Acrobat document [203.4 KB]


Dr. Duffy performs procedures at multiple hospitals and surgery centers throughout the North Dallas area. We will recommend the most appropriate facility for each patient based on their individual circumstances. Contact us at 972-439-3753 for further questions or to schedule an appointment.

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