Forms to Download
New Patient Forms
Print and fill out our paperwork at your convenience at home!  That
way, you will spend less time in the waiting room before your appointment.  
Just print and complete all five forms and bring them to the office for your
 Or, if you are able to fax / e-mail / mail / drop-off the
completed paperwork along with a copy of the front & back of your
insurance card prior to the day of your appointment, this would
greatly speed up your check-in process at the time of your
(You may download Adobe Reader to view the forms.  See below.)
Imprima y llene nuestras formas para que sea mas conveniente en
su casa!
De esa manera se va ahorrar tiempo en nuestra sala de espera
para que su cita sea mas rapida.  Imprima y complete todas nuestras 6
formas y traigalas con usted el dia de su cita.  (Usted puede bajar esto con
el programa Adobe Reader para mirar estas formas.  Vea abajo.)
Phone (214) 330-9299
Fax      (866) 846-5648
Richard C. Galperin, DPM, FAPWCA, PA
801 N Zang Blvd, Ste 103
Dallas, TX  75208
When you come to your appointment, please
remember to bring the following items:

These documents that you just printed and
Picture ID
All insurance cards
Co-payments (If you need information about
your insurance benefits and your financial
responsibility for the visit, please call our office
before your appointment.)
Your referral (unless you have been notified by
our office that we have received the referral
directly from your PCP)
Any X-ray films or previous tests or studies
performed (if applicable)
A list of all medications you are currently taking
and names of other doctors you may be seeing.
Formas Para Pacientes Nuevos