Patient Information

New Patient Information

New Patient Information

If you are a new patient of Medical Associates of North Texas, we welcome you! To save time at your first appointment, please download, print and fill out these forms before you arrive. Once complete, please be sure to bring them with you or Pre- Register on patient portal Online.

Click Below to Enter the Patient Portal

Please print and have ready upon your first appointment.

REGISTRATION FORM

MEDICAL RELEASE FORM

Hospitals

Covered

If you are experiencing a medical emergency, call 911.  

Please inform the Emergency room physician that MANT Provider is your Doctor . The ER physician will contact us to coordinate your care.

  • Baylor Scott & White All Saints Medical Center

  • Baylor Scott & White Rehabilitation

  • Medical City Fort Worth

  • Kindred Hospital

  • Texas Rehabilitation Hospital 

Make A Payment

Login to your Patient Portal to make a payment.

Insurance 

Policy

Nearly all major insurance plans accepted
Aetna
Aetna Health Plans / HMO 
Aetna Heath Plans /PPO
Aetna Medicare
Coventry First Health
Aetna Better Health Tx (Medicaid)
Amerigroup
Amerigroup Chip 
Americgroup Star Plans (Medicaid)
Amerivantage
BCBS
Blue Choice (PPO/POS)
Blue Cross Medicare Advantage
Clue Essentials HMO
Blue Advantage HOM 
Health Select 
Medicare Advantage PPO
Blue Premier
Out of state BCBS plans go thru PPO
Care N Care
Medicare Advantage
Cigna
Open Acces Plus
PPO
Cigna Healthspring 
Medicare HMO&PPO
Medicaid Star Plus
Cooks Children in process
CMCHP STAR Kids
Galaxy
HealthScope Dart
HealthSmart
Humana
Humana/ChoiceCare Commercial 
Humana Medicare Advantage Plans
Imagine
Medicare Traditional
Medicaid Traditional
Molina
Chip
Medicare Advantage
Multiplan
PHCS (many small plans)
NTSP
Humana Gold Plus HMO 
UHC Secure Horizon HMO
Quick Trip 
Scott & White
Superior 
Chip Perinate
Star Kids/Star Plus (Medicaid)
Medicare Advantage All Well 
Ambetter
Tricare
Certified
Dr Siripurapu has a Prime Contract
UHC
Medicare Advantage PPO
Medicare Advantage HMO 
Commercial
USE
(many small plans)
Well Care
*Not taking any new Medicaid Patients
 
How Can We Help You

CONTACT US

(972) 544-6600

(972) 544 6604 (fax)

PATIENT LINKS

© 2020 Medical Associates of North Texas