Patient Forms


 

FORMS

New patients can save time during the first appointment, or after three years of not seeing Dr. Roman-Pavajeau, by completing all paperwork prior to a visit.

Simply download, fill in the information requested, print them out and bring the completed forms with you to your appointment.

 

Medication, Allergies & Shots History Form

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Demographics
Form

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Covid 19
Waiver Form

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Consent
Form

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IMPORTANT DOCUMENTS NEEDED FOR YOUR APPOINTMENTS

We also encourage our new and established patients (established patients that have not seeing the doctor for more than 3 years) to bring the following items:

1. Most recent insurance card (establish patients as well)
2. Driver License or ID
3. Referral from your Primary Care Physician (if you got it)
4. An updated list of your medications (for those established patients)
5. Any medical record you may have
6. Any laboratories or test results pertaining to your condition
7. A report of any previous surgical procedure you have, only if relevant.

By having all this information with you, you will make your visit more efficient and expedited.

Thank you for your cooperation, we look forward to taking care of you!

 

What we offer

Procedures

Location
Jaime Roman-Pavajeau, MD, PA
1331 West Grand Parkway North, Suite 330
Katy, TX 77493
Phone: 281-318-6770
Fax: 281-693-5459
Office Hours

Get in touch

281-318-6770