Care Acknowledgement

Please correct the errors described below.

Fort Worth Perinatal Associates, P.A.

Tracy Papa, D.O., F ACOOG / Rebecca Reyes, M.D., FACOG

I fully understand and acknowledge that Fort Worth Perinatal Associates, P.A. is a specialty practice which I have been referred to by my primary OB physician, on a consultation basis only. My Obstetrician will continue to care for me during my pregnancy and will be delivering my baby. I also understand that it is vital for me to continue seeing my Obstetrician for regularly scheduled appointments, even if I have an appointment with Fort Worth Perinatal Associates, P.A. the same day or same week.

By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.

Your message will be encrypted.