Referral Forms for Healthcare Professionals
New Patient Referral Form – Maternal-Fetal Medicine
New Patient Referral Form – Pediatric Cardiology
Medical Records Release Forms
Medical Records Release Form – From FCC
Medical Records Release Form – From Outside Facilities
Fetal Care Center Dallas no longer accepts new patient forms as PDFs. All new patients must submit their information through Phreesia, our patient portal. Please contact the office with any questions you may have.
Office visits are by appointment only. Please call us to schedule a visit.
Cancellation & No-show Policy
When you make an appointment with us, we reserve a significant amount of time specifically for your consultation. Unfortunately, when a patient doesn’t show up for their scheduled appointment, another patient loses an opportunity to be seen.
Please phone our office as soon as you are aware that you will be canceling your appointment. You can also use the link you received in your appointment confirmation text message to request to cancel or reschedule your appointment and the office will call to follow up with you during business hours.
Any patient that does not arrive for their scheduled appointment within a 15-minute window and does not call to cancel at least 24 hours prior to their appointment is considered a no-show. Patients that do not follow this protocol will be assessed a $50 no-show fee.
The only exceptions to this requirement are a medical emergency, inpatient hospitalization, or a crisis. For those patients utilizing Medicaid transportation, if your transportation is a no-show, you must obtain a letter from Medicaid stating such in order to waive the no-show fee for our office.
Participating Insurance Carriers
- BlueCross BlueShield Texas
- United Healthcare
These are just a few insurance carriers that Fetal Care Center Dallas has contracts for service. Please check with your insurance plan to ensure covered services or limits in your policy. It is your responsibility to understand the provisions, limits, and requirements of their individual benefit plan(s) and advise us accordingly.
Patients are responsible for any bills not paid by their insurance. If your plan denies payment for services because
- a plan requirement was not met,
- services were considered “non-covered,”
- the plan benefits were exceeded,
- care was considered medically unnecessary, or
- treatment is considered experimental,
among other reasons, you will still be held accountable for those charges. Furthermore, if ‘clean claims’ submitted to an insurance carrier are not paid within the 30-day limit established by the Texas Prompt Payment Regulations, FCCTX reserves the right to bill you directly for our services.