Houston Methodist. Leading Medicine

Patient Resources & Forms


West Houston/Katy

Medical Office Building 1
18400 Katy Freeway, Suite 200
Houston, TX 77094
Phone: 832-522-8280 or
View Google Map

Download our Campus Map (PDF)

Our Physicians

Winfield Campbell, M.D.
Pedro Cosculluela, M.D.
D. Dean Dominy, M.D.*
HoSun Hwang, M.D.
Shari Liberman, M.D.*
Christopher K. Smith, M.D.

These forms and informational documents are provided to patients to expedite your physician visit and the registration process. Locate your physician's name below, then download, complete, and print the appropriate forms. Please have them with you at your next visit.

All forms are in PDF format and can be opened using Adobe Acrobat Reader. Adobe Acrobat Reader is a free application and is available for download.

Dr. Winfield Campbell

  • New Patient Packet

    Dr. Pedro Cosculluela

  • New Patient Forms: Medicare
  • New Patient Forms: Non-Medicare

    Dr. D. Dean Dominy, III

  • Consent to Treat
  • Medical History Form
  • Patient Financial Form
  • Release form for Minor
  • Dr. Hosun Hwang

  • New Patient Packet
  • Oswestry Disability Index

    Dr. Shari Liberman

  • New Patient Forms

    Dr. Christopher K. Smith

  • Consent to Treat
  • Medical History Form
  • Patient Financial Form
  • Release Form for Minor

    Outpatient Rehabilitation Forms

  • Tuberculosis Exposure Questionnaire
  • Outpatient Medical History Questionnaire
  • Outpatient Fall Risk Questionnaire
  • Ambulatory Summary List Form
  • Our Specialties

    Where Does It Hurt?

    Our Locations

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