If you are new to Kidney 360 and have scheduled an appointment, please complete the appropriate New Patient Intake form below. Be advised, you may be asked to take picture or scan your insurance information and identification cards.
Our intake forms are LIVE! We are able to send you secure intake forms to your email or cell phone. Now you or your family can fill out all forms and provide all insurance information prior to any visit - SAVING you from frantically filling out the paper work during the visit and allowing you to spend more time with your care team.
By filling these forms out prior to your visit, you will have a more efficient visit on the day of your appointment.
New Patient
Intake Form
Patient Email
Consent
Records Release
Request
HIPAA
Acknowledgement
and Consent
Patient Request for
Medical Records
Kidney 360 maintains medical records for each patient treated in our clinic and facilities. To request your medical records, please click on the below on-line links or call 713-597-5131. Please be advised you will be asked to complete the appropriate form and also provide proof of your identification with a valid, government issued photo ID. Requests for medical records generally take up to 24 hours to process.
Legal Records
IF you are a representative of an attorney's office, or an insurance plan, please go to our online medical records transaction portal and fill out the required fields.
