NEW PATIENT REGISTRATION

Acceptable Documentation to Establish Eligibility (physical or copy of):

Adult

  • Certificate Degree of Indian Blood (CDIB); Tribal Membership Card; OR
    • legal documentation proving descendancy in the first or second degree from a person possessing a Certificate of Degree of Indian Blood (CDIB) Card or Tribal Enrollment Document (documentation must be approved by TNH staff) 
  • Driver License or State Issued ID
  • Social Security Card
  • Health Insurance Cards if Insured (insurance information must be provided for those with existing coverage)
  • List of current medications and full medical history

Minor

  • CDIB; Tribal Membership Card; Letter of Descendancy; or

CDIB, Tribal Membership Card, or Letter of Descendancy of parent

  • Social Security Card
  • Immunization Record
  • Birth Certificate – Plus (if parent is not listed on birth certificate) Adoption Decree, Marriage License, Custody Order from Child Welfare Agency, Notorized Affidavit from eligible parent attesting to parentage, or Guardianship Order.

Documentation Required for Name Change:

  • An established patient who desires to have his or her name changed on his or her medical record shall submit one of the following documents reflecting the name change:
  • Marriage License
  • Divorce Decree
  • Annulment Decree
  • CDIB
  • Document issued by a federally or state recognized Native American Tribe

Adult New Patient Appointments

To initiate the establishment of a patient chart at Texas Native Health, it is required to complete the new patient registration forms accessible through the button below. Including the requested documentation is mandatory for the establishment of a new patient chart. Subsequently, our Medical Records staff will contact you utilizing the information furnished in the patient registration form to arrange your initial appointment.

New patient appointments must be completed before additional services can be rendered.