Health Center of Southeast Texas |307 North William Barnett AvenueClevelandTX77327 | (281) 592-2224

Patient Forms

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Patient Forms

Here is where you'll find all the necessary paperwork, information, and resources. Please download and complete the appropriate forms before your appointment. You may email your completed form to or bring it with you to your appointment. For instructions on after-hours access, please contact your local office.

New Patient Forms

Coming Soon

Medical Records Forms

Medical Records Department -
Corporate office located in
307 North William Barnett Ave
Cleveland, Texas 77327
Fax: 346-414-3084

Behavioral Health Forms

Telepsychiatry/Telemedicine Forms

Coming Soon

HIPAA/Privacy Practice Notice

Coming soon

Patient Rights and Policies

The Health Center of Southeast Texas is committed to respecting the privacy and confidentiality of each of our patients. In accordance with the standards of medical practice and the Health Insurance Portability and Accountability Act (HIPAA), the Health Center of Southeast Texas has established a Privacy Policy.

At your first appointment and then annually, you will be asked to sign an acknowledgment that you have been offered a copy of our PRIVACY POLICY.

Our Mission
Our mission is to provide accessible, compassionate, culturally competent, and quality health care affordable for all, regardless of ability to pay.

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