Request an Appointment
By completing the form on this page, you can send us a secure message that will be answered by our International Services Center staff. Every effort will be made to respond to your request within two business days.
If you need to speak to someone immediately, please call the International Services Center at 713-704-5515 or toll-free at 800-790-7890. Our office hours are Monday through Friday from 8 a.m. to 5 p.m. Central Standard Time (USA).
Please note the required documents needed to process your Appointment Request. These may be faxed to our office at 713-704-6493.
- Patient's personal information:
- Full name, date of birth, home address, native country, home and work telephone in native country (city and country codes), fax, cellular, e-mail, emergency contact name and telephone number
- Financial responsibility: self-pay, letter of guarantee, International Insurance
- If patient is a child (18 years of age and under):
- Name of Guarantor and/or Legal Guardian
- Guarantor and/or legal guardian dates of birth, contact information and financial responsibility
- Medical history documentation (English preferred):
- Medical reports supporting diagnosis
- Referring physician and contact information
- Copies of radiology films, lab work, physician notes, current medications and past surgeries