Patients/Visitors

Patient Forms

We are pleased to have you as our patient at Las Colinas Medical Center and are committed to helping you in any way possible. Here you can find some policies and forms that may be of assistance to you during and after your stay.

To read a copy of our Patient Guide, click here.

To read a copy of our Notice of Privacy Practices, click here.

To PRINT a copy of our Notice of Privacy Practices, click here.
To PRINT a copy in Spanish, click here.


To Request Patient "Release of Medical Information":

For a copy of our Release of Medical Information Form, click here.
For a copy in Spanish, click here.

All forms may be faxed to Healthport at 469.484.2006 or submitted in person to the concierge from 8am - 8 pm daily.

Please understand your physician can request the information on your behalf and receive the information electronically.

You may also phone HealthPort at 469.420.6796


For Film requests fax the Release of Medical Information Form to:

469.484.1343 for Women's Imaging
972.969.2503 for Main Radiology