Patient Portal(972) 369-4220

New Patient Intake Form

Please fill out the form below to get started as a new patient. Our team will contact you within 1 business day to schedule your first appointment.

Please share only what is needed to schedule your visit. Do not include detailed clinical notes or sensitive medical history here — we will review those securely during intake. Submissions are transmitted over HTTPS (encrypted in transit) via POST so values are not placed in the page URL, and are used to process and respond to your request. See our Privacy Policy.

Keep this high-level. Do not include detailed medical history or clinical notes.

Contact Information

Phone

(972) 369-4220

Email

info@exulthealthcare.com

Hours of Operation

Mon-Fri: 9:00 AM – 7:00 PM
Sat-Sun: Closed

Already a patient? Log in to the Patient Portal