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Schedule a Wound Care Appointment

Please complete the form below to request an appointment with the Wound Care Program* at a Texas Health Resources hospital near you. A representative will contact you within one business day.

*A service of Diversified Clinical Services, Inc.

* Indicates required information
First Name * 
Middle Initial 
Last Name * 
Street Address * 
Address 2 
City * 
State * 
Zip * 
Address Type * 
Employer 
Home Phone 
Work Phone 
Cell Phone 
Fax 
E-mail Address * 
Gender * 
Date of Birth (MM/DD/YYYY) 
Children in Household? * 
Health Insurance? * 
Primary Care Physician? * 
Preferred Hospital * 
Comments 
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