Please print and complete. Completed form may be faxed to 214-750-1971 or brought with you to the first appointment. Copies of the form are also available at Dr. LaValle's office.
Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.
Michael LaValle, Ph.D.
7557 Rambler Rd
Dallas, TX 75231