Important Patient Notice: Please be advised of temporary changes to our office schedule. For assistance or appointment information, call (972) 514-3530.
4500 Hillcrest Rd, Ste 185, Frisco, TX 75035
5800 Communications Parkway, Plano, TX 75093
(972) 514-3530
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GI AlliancePh (972) 265-4190Fax (972) 265-4189HealthmarkFax (800) 833-5935
Texas Gastroenterology AssociatesDr. Adnan Badr5800 Communications ParkwayPlano, TX 75093Fax (972) 514-3531
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This authorization expires one year from the date signed unless I write an earlier date or event in the box below. I may revoke it in writing to GI Alliance, Healthmark, or TGA Medical Records; revocation does not affect disclosures already made. Treatment is not conditioned on signing except when care is provided solely to create records for a third party. Information disclosed may be redisclosed by the recipient and may no longer be protected by HIPAA. I am entitled to a copy of this authorization.