SUZANNE GAZDA M.D.
  • Home
  • Meet Dr. Gazda
    • Our Practice
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    • Blog - Long Covid
    • Blog - NEUROLOGY TRENDS
    • Blog - MS in the NEWS
    • Blog - Scientifically Speaking
    • Blog - Guest Articles
  • Our Approach
  • Conditions we treat
    • Alzheimer’s Disease
    • Amyotrophic Lateral Sclerosis (ALS)
    • Long COVID
    • Multiple Sclerosis (MS)
    • PANS | PANDAS
    • Parkinson’s disease
  • Treatment Protocols
  • Patient Stories
  • FAQ
  • Policies & Rates
  • Helpful LInks
  • Medical Resources
  • Journal Articles
  • Product Recommendations
  • Become a Patient
  • NEWS
  • Contact

Becoming a patient

If you are interested in becoming a patient at Suzanne Gazda M.D., please complete the new patient inquiry form below and we’ll be in touch shortly. You may also contact us at  210-692-1245 to speak with a staff member. Please do not send any personally identifying information or details specific to your health or current prescriptions via this form.

    You may complete the form online below, print and return to us by email or regular mail – feel free to contact us to have this or any other forms sent to you by postal mail. Just let us know how we can best help!

    Preliminary New Patient Form

    List name and contact information
    Name and contact information
Submit
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Downloadable Patient Forms

Package of forms for ADULT patients only.
Download and complete these fillable forms.
You can submit completed forms directly using the “submit" button, or save and attach the forms to your own email and send to:
[email protected]
ADULT PATIENT FORMS.zip
File Size: 1310 kb
File Type: zip
Download File


Package of forms for PEDIATRIC patients only.
Referrals limited at present to patients 12 years of age and older. Download and complete these fillable forms. You can submit completed forms directly using the “submit" button, or save and attach the forms to your own email and send to:
[email protected]
PEDIATRIC PATIENT FORMS.zip
File Size: 656 kb
File Type: zip
Download File


All forms are available individually below.
Adult Patient Questionnaire.pdf
File Size: 2055 kb
File Type: pdf
Download File

Pans & Pandas-Childrens Intake Questionnaire.pdf
File Size: 571 kb
File Type: pdf
Download File

Patient Information Fillable.pdf
File Size: 87 kb
File Type: pdf
Download File

Consent to Treat Fillable Form.pdf
File Size: 37 kb
File Type: pdf
Download File

HIPAA NOTICE.pdf
File Size: 51 kb
File Type: pdf
Download File

Patient Notices.pdf
File Size: 44 kb
File Type: pdf
Download File

Patient Office Policies.pdf
File Size: 62 kb
File Type: pdf
Download File

Privacy Practices.pdf
File Size: 70 kb
File Type: pdf
Download File


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SITE MAP

HOME
MEET DR. GAZDA
OUR PRACTICE
INTEGRATIVE MEDICINE
OUR APPROACH
CONDITIONS WE TREAT
TREATMENT PROTOCOLS
PATIENT STORIES
FAQ
POLICIES & RATES
BLOG
SCIENTIFICALLY SPEAKING
MEDICAL RESOURCES
JOURNAL ARTICLES
LINKS
BECOME A PATIENT
CONTACT
NEWS
PRODUCT RECOMMENDATIONS

Location

San Antonio, Texas

Telephone

210-692-1245
Fax
210-692-9311

Email

[email protected]
  • Home
  • Meet Dr. Gazda
    • Our Practice
  • Lectures/Videos
  • BLOGS
    • Blog - Long Covid
    • Blog - NEUROLOGY TRENDS
    • Blog - MS in the NEWS
    • Blog - Scientifically Speaking
    • Blog - Guest Articles
  • Our Approach
  • Conditions we treat
    • Alzheimer’s Disease
    • Amyotrophic Lateral Sclerosis (ALS)
    • Long COVID
    • Multiple Sclerosis (MS)
    • PANS | PANDAS
    • Parkinson’s disease
  • Treatment Protocols
  • Patient Stories
  • FAQ
  • Policies & Rates
  • Helpful LInks
  • Medical Resources
  • Journal Articles
  • Product Recommendations
  • Become a Patient
  • NEWS
  • Contact