©2017 BY DOMINION PRIMARY CARE. PROUDLY CREATED WITH WIX.COM

Contact

Dr. Chrissy Navejar

Direct Primary Care Provider

MyDPC@DominionPrimaryCare.com

T (210) 245-5580

F (210) 245-9996

Se habla español

Address

23535 IH 10 W

Suite 2205

 San Antonio, TX 78257

Boardwalk Shopping Center on the 2nd floor on the right

How to Enroll

 

1. Complete online enrollment 

 2. Schedule an appointment online or call the office

3. Print out and complete required* membership forms or complete forms online

 

       

   Clinic enrollment forms

 

 

   *New membership agreement                                           

        (Please complete prior to your appointment)

     Notice of HIPAA Privacy Practices

     (Please read before signing HIPAA form)

      *HIPAA Acknowledgement

     (Please complete prior to your appointment)

    *New patient health history form

        (Please complete prior to your appointment)

    *Release of Medical Information

        (Please complete prior to your appointment)

    *Credit Card Authorization

        (Please complete prior to your appointment)

       *Medicare Opt-Out Form

      (Please complete prior to your appointment if Medicare Eligible)

      Corporate Enrollment Form (fillable online)

      Corporate Enrollment Form (printable)

     

  Advance Directive forms

      Advance Directives (Living Will)

      Out of Hospital DNR 

      Medical Power of Attorney