Online Forms

Permian Basin Accident & Injury Clinics offers our patient form(s) online so they can be completed in the convenience of your own home or office.

If you do not already have AdobeReader® installed on your computer, click here to download.
Download the necessary form(s), print it out and fill in the required information.
Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding can we help you with? Let us know!

I feel certain that the treatment I received their expedited the healing process for me. Not only did they treat my injuries from my accident, I also left there with a new awareness of taking care of this body. Every medical office should strive to be like this one.

- Marsha C
When you go there they make you feel like family which is rare these days. Thank you Doc and especially Ashley for all u have done for me. If I ever need more help I will be coming back here.

- Trina M
Dr. Gonzales and staff have been helping me recover from a motor vehicle accident, and they have been the most sincere and caring people I have ever met.

- Amber S
I find them to be very professional and caring and I would recommend them to anyone I know.

- Billy S
Dr. Guerrero and staff are really sweet and explained everything throughly. Looking forward to starting my therapy!

- Rosalia C
They are friendly, very respectfully and considerate towards others cultures. They treat their patients with kindness and have expertise in taking care of other people.

- Magda AK