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Patient Forms

Please find Milepost Medical forms below:

Find all of the forms we use for our patients below.

New Members:

New Sleep Consults:

New Patient Packet – Adult Sleep Consult  

Medical History Forms

Adult Medical History  


Children (5 years and older)  


Children (Birth to 5 years old)  

Miscellaneous Forms:

Email Consent Form  


Notice Of Privacy Practices  


Notice of Privacy Practices Signature Page  


Patient Medicare Agreement  


Sleep Screening Questionnaire  


Transfer Medical Records Authorization  

Phone

832-912-4820

Email

info@milepostmedical.com

Address

18220 State Highway 249
Suite 335
Houston, Texas 77070

Clinic Hours

Monday – Friday:  8 AM – 5 PM 

Available outside these hours by special appointment.