If you are a new patient, please complete the New Patient Check-in Sheet and Acknowledgement of Receipt of Privacy Notice Form and submit them. We will then call you to schedule an appointment. See also New Patient Registration page.
Submit forms via email, or use our secure Medical Records Upload page.
The Acknowledgement of Receipt of Privacy Notice Form can be completed and signed electronically and sent to us via email or uploaded using our Medical Records Upload page.
Need Adobe for your mobile device? See link for more information:
Need Adobe for desktop? See link for more information:
To complete Check-In Sheet online, go to New Patient Registration. Or, if you prefer, use the downloadable form below. It can be completed electronically and submitted via email or uploaded using our Medical Records Upload page.
If you need to transfer medical records to us, you can use the form below. It is pre-filled with our contact information.
Want to send us medical records right from our website? Click here.
If you have Medicare (part B), you must sign this agreement to be seen in our office.
If you (or your child) have Medicaid, you must sign this agreement to be seen in our office.
Family Health PLLC
18423 FM 1488 Rd Suite C
Magnolia, TX 77354
Paul Dibble MD
Alyson Van Tiem PA-C
Traffic in Magnolia can be surprisingly heavy; plan plenty of time for travel when coming to our clinic. See Driving Directions
We are moving soon!
We are scheduled to be in our new clinic 07 JUL
Our new address will be:
827 S Magnolia Blvd Ste 6
Magnolia, TX 77355
We do not take insurance
We accept cash, check, credit/debit cards