FW Center for Pelvic Medicine

Patient Desk


New Patients

Click on the “Patient Information Packet” link below. The person making your appointment will let you know which forms will be required. You may fax the completed forms to 817-924-3222 or bring them with you.

Current HIPPA regulations require each patient to be given the “Notice of Privacy Practices” statement for our practice. These forms will be provided to you when you arrive for your visit.
We are looking forward to seeing you and serving your healthcare needs.

Patient Information Packet

Dr. Ripperda Patient Questionnaire

Current Patients

If you would like to make an appointment, email us with the date and time you would prefer. Please include your full name, birthdate, reason for visit, and phone number. We will respond promptly.

For laboratory results, reports, and questions, please include your full name and date of birth so that we can access the appropriate file.

If it has been over 12 months since your last visit or if your insurance coverage, address, phone number, or other demographic information has changed, download and complete the “Patient Information Packet” below. Complete those areas that have changed from your last visit and bring the form with you to your visit.

Exit mobile version