New Patient Information

To schedule an appointment, please call Dr. German Corso at (956) 803-2111 between the hours of 9am to 5pm, Monday thru Friday, and fill below the new patient questionnaire providing your child’s information and reason for requesting the appointment. Once you have scheduled a new patient appointment with Dr. Corso, you will need to download, print and fill out all the following forms.

Referred By:
Today's date:*
Who is this appointment for? Please provide potential patient information as it appears on legal documents.
Patient's legal name:*
First Name Last Name
Patient's sex:*
- Male
- Female
Patient's age*
Patient's birth date:*
Name of school and Grade Level*
Parent Name / Guardian Name :
First Name Last Name
Marital Status of the parent / guardian:
- Single
- Married
- Divorced
- Widow(ed)
Patient/guardian's address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Patient/guardian's phone #1*
Patient/guardian's phone #2*
Patient/guardian's e-mail*
Occupation of patient / Guardian*
Why are you requesting this appointment/ current concerns?
Have there been other evaluations done and if so what and where?
Please provide additional information regarding the patient's symptoms or needs.*
Please list any previous treatment and if so where?*

Dr. German E. Corso

New Patient Information

Dr. German E. Corso