Forms and Policies

Download commonly used patient medical and referral forms and review our office policy information to ensure you are well-informed about your rights and responsibilities as a patient.

Patient Forms

Patient Policies

At UT Health Austin, we strive to create a welcoming and respectful environment for our medical teams to deliver healthcare for you and your family. We encourage you to participate in your care process. Together, by working with you in a safe, respectful, and honest way we can provide the best care to you.

To ensure the best care experience for yourself, other patients, and your care teams, we respectfully request that you:

Be considerate when using your cell phone or other electronic devices at UT Health Austin.
Arrive on time for your appointment, ideally 10-15 minutes early. To respect the time and needs of patients who do arrive on time, any patient who is more than 30 minutes late for a scheduled appointment may not be seen and will likely be rescheduled.
If you must cancel an appointment, we ask that you please do so as soon as possible, at least 24 hours in advance. We know that plans may change at the last minute, so even late notice is appreciated. Patients who miss more than 3 appointments may not be able to be rescheduled and will be notified.
You must get permission before taking photographs/videos or voice recordings of anyone on your medical team.

To ensure a safe and respectful working environment, UT Health Austin finds certain behaviors to be unacceptable. These behaviors could lead to removal from the building and/or dismissal from the clinic.

Examples of unacceptable behaviors are:

Disrupting another patient’s care or experience
Bullying, intimidating, harassing staff or other patients
Engaging in: profanity, assault, or infliction of bodily harm to self or others
Engaging in or threatening violent behaviors either in person or in communications
Making vulgar or derogatory remarks associated with race, ethnicity, sexual orientation, culture, language, age, disability, veteran status, or immigration status
Requests, demands, or denial for clinical, learners, or another staff member (s) based on the above
Damaging UTHA property or equipment
Possessing illegal weapon(s) in prohibited areas
Making requests that would constitute unethical or illegal behavior on the part of UTHA

UTHA has a zero-tolerance policy for aggressive behavior directed toward our providers, learners, and staff. If you personally experience or notice any alarming or unsafe behaviors, please report them to a member of our staff immediately.

Download a copy of this policy in English or Spanish.

Approved: 1/12/24

UT Health Austin (UTHA) and Dell Medical School (DMS) will reasonably accommodate patients and visitors with their service animals in compliance with federal[1] and state[2] laws, and this policy. A service animal means an animal (generally a dog) that has been specially trained or equipped to perform specific tasks directly related to the handler’s disability. Animals whose sole function is for emotional support, therapy, comfort, or companion are not considered service animals.

A service animal:

Will be permitted to accompany its handler and enter the UTHA/DMS premises open to the public;
May be permitted to accompany its handler and enter the areas not open to the public. Gaining admittance to such areas will be determined on a case by case review by the Executive Director of UTHA.
Will not be permitted to accompany its handler and enter sterile areas, or clean rooms, where special precautions (such as wearing gloves, masks, and/or gowns) are required for the purposes of infection control. These areas include but are not limited to operating rooms, procedure rooms, recovery rooms, and other sterile areas.

A service animal may be denied admittance to or removed from the UTHA/DMS premises if the service animal:

Exhibits aggressive behavior including, but not limited to, biting, excessive whining, barking, growling, scratching, or teeth baring;
Is excessively noisy;
Poses a direct risk to the safety and health of other service animals or people;
Is not under the control of the handler;
Is not well groomed or does not appear healthy, in which case our staff will ask for proof of vaccination or the dog’s health records prior to entering the premise.

It is the patient/handler’s responsibility to supervise, control, and care for the service animal, including the removal of the animal from the premises. UTHA/DMS will coordinate an alternative care for the animal at the handler’s expense if handler cannot perform such responsibilities.

Under the applicable laws, our staff will not ask you of the following:

The qualifications of the service animal or the nature of the person’s disability;
Require or request medical documentation, special identification card or training documentation for the service animal;
Request that the service animal demonstrate its ability to perform the work or task.

However, in situations where the handler’s disability is not readily apparent, our staff may ask the following questions for clarification:

Is the dog a service animal required because of a disability?
What work or tasks has the dog been trained to perform?

The service animal that enters the premises must always be on a leash or harness.

If you have questions about bringing service animals onto the UTHA/DMS premises, contact the Executive Director of UT Health Austin and/or the Compliance Office.

Download a copy of this policy here.

[1] https://www.ada.gov/2010_regs.htm

[2] https://gov.texas.gov/organization/disabilities/assistance_animals#responsibilities

Forms and Policies

Patient Forms

Notice Concerning Complaints

Aviso Sobre Las Quejas

Patient Policies

Discrimination Is Against the Law

UT Health Austin provides free aids and services to people with disabilities to communicate effectively with us, such as:

UT Health Austin provides free language services to people whose primary language is not English, such as: