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Coastal Bend Family Medicine, P.A.

Coastal Bend Family Medicine, P.A.Coastal Bend Family Medicine, P.A.Coastal Bend Family Medicine, P.A.

(361) 993-1747

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    • Meet Our Doctor
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    • Contact Us
    • FAQ
    • COVID-19
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(361) 993-1747

Coastal Bend Family Medicine, P.A.

Coastal Bend Family Medicine, P.A.Coastal Bend Family Medicine, P.A.Coastal Bend Family Medicine, P.A.

  • Home
  • Meet Our Doctor
  • Services
  • FORMS
  • Contact Us
  • FAQ
  • COVID-19
  • Patient Portal

Medical documentation and administrative fees

Medical Records & Physician Forms

Copies of Medical Records

$25.00 and up

$25.00 for the first 20 pages / $0.50 for each additional page

Physician Narrative

$50.00 and up

$50.00 for the first 2 pages / $20.00 for each additional page

Legal/Litigation Forms

$125.00

Affidavits

$15.00

Disability Determination Services

$18.00

Administrative Fees

Itemized Billing Statement

$25.00

with Texas State Notary Seal 

Notary Public Services

$10.00

Texas State Notary - Must be present with valid ID

Overnight Postage & Handling

Variable

Must be paid prior to release

Miscellaneous Forms and Fees

Variable

Please call the office during normal business hours for form specific charges.

Please note that a signed medical records affidavit must be provided before records will be sent. we accept cash, checks, money orders and debit/credit cards. please make checks/money orders payable to: coastal bend family medicine, p.a.

Downloads

Here are some links to forms and tools to help you and our staff manage all your healthcare needs! Please print and fill out forms to be returned to the office. You may scan and email the forms to CBFMPA@cctxdoc.com or send via fax (361) 993-1748. If you have form filler software, you can fill online and email the forms direct.


New Patient Packet with Minor Consent (pdf)Download
VTR-214 Disability Placard (pdf)Download
CBFM Medical Release Form (1) (pdf)Download
Blood Pressure and Glucose Tracker (xlsx)Download
Blood Sugar Tracker (1) (xlsx)Download
His and Hers Weight Loss Tracker (xlsx)Download
Medication Log (xlsx)Download

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