Complete your secure intake and consents
If you have paid for your refill review, or are using the BCBSTX PPO coverage-verification pathway, complete your clinical paperwork here. Do not pay again just to access your form.
English — intake and consentsOpen the secure DashQuill form.→Español — ingreso y consentimientosAbrir el formulario seguro en español.→
After submitting your form
Keep your phone nearby. Requests are reviewed during business hours; review times vary. New patients are contacted by phone or secure video before prescribing. A prescription is not guaranteed. If you are unsure whether your form was received, call 469-951-0477 before submitting again.
Haven’t started yet? Check eligibility and choose self-pay or BCBSTX PPO.
Use the secure form for medical details; ordinary text and email are not for clinical intake.