Book an Online Appointment

Thank you for your interest in scheduling a new patient appointment with Healthy Living Dallas. Please complete the following information fields and click submit below. This information will be sent to our office staff who will perform a courtesy insurance verification and call to schedule a new patient appointment within 24-48 business hours. We look forward to helping you on your health journey.

Your Personal Details

• First Name*
• Last Name*
• Address
• City*
• State*
• Zip Code*
• Phone Number*
• Email Address for new patient paperwork*
• Date of Birth*
• Do you have medical insurance at this time?
• Yes NO
 
(If yes, please complete the following questions:)
Insurance Carrier: (example: Blue Cross Blue Shield, United Healthcare, etc.)
Member ID Number
Group #
• Are you the primary holder on the insurance policy
• Yes No
 
(If no, please complete the following questions:)
First and last name of primary holder on the insurance policy:
Date of Birth of primary holder on insurance policy
Relationship of primary holder on the policy to the individual having new patient appointment:(ex. spouse, child, parent, etc.)

 

Please verify the information above for accuracy. Our office staff will perform a courtesy insurance verification that will allow us to estimate the amount of your new patient appointment that will be covered by insurance. If you do not have medical insurance you will receive information on cash pay prices when our staff calls you to schedule in the next 24-48 business hours. Thank you for considering Healthy Living Dallas!