PATIENT INFORMATION

Insurance Coverage Information

Please review the list of insurers we take (below). Note we only take PPO and not HMO.

Now In-Network With These Providers (PPO Only)

• Aetna
• Cigna
• Medicare
• Humana
• BCBS
• Centene Corporation
• UHC
• Magellan Health

Completing The AMCOT Medical Forms

If you are a new patient, please follow the instructions below to complete our medical forms and submit them to AMCOT before your first visit. For your convenience, we have made the forms available on this site. By filling out the forms in advance, you can help ensure a smooth and efficient check-in process.

There are a couple of options when filling out the required medical forms. The text below gives you all the information on the best ways for doing this.

Option 1 – Fill forms out by hand & fax them to Addiction Medicine Consultants of Texas (DO NOT MAIL them.)
All of the forms are in a single PDF document. To fill them out do the following:

1. Download the AMCOT Medical Forms Packet
2. Print out the entire document
3. Fill out the forms completely and sign them
4. Fax the forms to (512) 647-1301 (make sure to include your name and birth date on the cover sheet)

Option 2 – Fill forms using your computer and upload to Addiction Medicine Consultants of Texas (Recommended)
Due to the large amount of required information to enter you may download the forms and fill them out on your computer. Once completed, you may upload the filled out forms using the upload button below.
These forms were designed to make it easier to fill out on the computer. There are a number of fields that are duplicate across pages and forms. When filling out these forms electronically, duplicate fields will be automatically filled in when you enter the first one. There are other calculations done during surveys that will automatically be calculated when filling it out on a computer.

We recommend filling it out on a desktop/laptop computer (not a mobile device such as a phone or tablet) using one of the following applications:

• The Google Chrome browser
• One of the following Chromium based browsers, Vivaldi or Microsoft Edge. Note: Not all Chromium browsers will work, or have been tested. We only recommend using the ones listed.
• Adobe Acrobat (if you already use it and have an Adobe subscription). If you do not have one of these apps, it will be worth downloading and installing it for filling this out. Links are provided below to download one of the applications for this.

Please note, other software (web browsers, PDF viewers, etc.) may work, partially work, or not work at all, Software such as Safari, Opera, Preview, PDF Expert etc. do not seem to work correctly, while Firefox appears to work with some caveats. The applications linked to below are the only applications verified to work correctly.

To make it easier and and more secure, once you are finished filling out the foirms, please upload the document containing your completed forms using the secure upload link below. DO NOT EMAIL FILLED OUT FORMS!

If you have any questions or need assistance with the forms, please don’t hesitate to contact our office. We look forward to welcoming you as a new patient at Addiction Medicine Consultants of Texas.

Downloading & Filling Out Forms

1. Download and install one of the following (if not already using):

• Google Chrome
• Vivaldi
• Microsoft Edge
• Acrobat (Acrobat Reader)

2. Return to this page in one of the above browsers and download the AMCOT Medical Forms Packet. To expedite processing, please rename the PDF from AMCOT_COMPLETE-LM-PACKET.pdf to your full name and date of birth (minus the \slashes\).

For example, John_Smith_07041998.pdf

Note: If using Adobe Acrobat, open the downloaded form and fill it out in Acrobat. Otherwise, use one of the other three browsers.

When using a browser you may download the PDF first and then reopen inside the web browser or fill out the forms right inside the browser, then click the download icon (arrow pointing down to a line) next to the printer icon on the right side. Choose “With your changes.” Note: to sign the forms you can type your name inside the signature line. Once completely filled out, saved, and renamed, go to step 3.