Forms for Patients
New Patient Registration Form
Fill out this form if the patient is over 18 years of age.
Please download file and print information.
Patient Registration Form.pdf
Adobe Acrobat document [56.1 KB]
Fill out this form if the patient is over 18 years of age.
Please download file and print information.
Patient Registration Form.pdf
Adobe Acrobat document [56.1 KB]
Pediatric History Form
Fill out this form if your child will be the patient and he/she is under 18 years of age.
Please download file and print information.
Pediatric-Patient-History-Form.pdf
Adobe Acrobat document [139.2 KB]
Fill out this form if your child will be the patient and he/she is under 18 years of age.
Please download file and print information.
Pediatric-Patient-History-Form.pdf
Adobe Acrobat document [139.2 KB]
Health History
All patients must fill out this form.
Please download file and print information.
HealthHistory.pdf
Adobe Acrobat document [161.7 KB]
All patients must fill out this form.
Please download file and print information.
HealthHistory.pdf
Adobe Acrobat document [161.7 KB]
Contact Us
Dr. Antonio M. Diaz Jr. M.D., P.A.
864 Central Blvd
Suite 100
Brownsville, TX 78520
Phone
(956) 541-5231
Fax
(956) 541-9588
Hours
Appointments
Monday 8:00 am - 11:00 am & 2:00 pm - 4:00 pm
Tuesday 8:00 am - 11:00 am & 2:00 pm - 4:00 pm
Wednesday 8:00 am - 11:00 am
Thursday 8:00 am - 11:00 am & 2:00 pm - 4:00 pm
Friday 8:00 am - 11:00 am & 2:00 pm - 4:00 pm
Walk-ins are welcome between the hours of 8:00 am - 10:30 am and 2:00 pm - 3:30 pm, except for Wednesday afternoon
News
New Online Presence
Explore our new website to find out everything about our practice and the latest in medicine.
Patient Information
Everything you need to know about your visit to the doctor.
Print
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