CPAM - Artist Registration

At the Center for Performing Arts Medicine, registering yourself as an artist in the Houston Methodist system provides you with access to clinicians with expertise in working with artists. In addition, you will be included in Artist Health and Arts related communications.

• Financial Assistance: If you do not have health insurance and believe you qualify for financial assistance, please call our Financial Counseling office in Patient Access Services at Houston Methodist Hospital. The phone number is 713.441.6807 and they will be pleased to answer any of your questions about the program and arrange a meeting with a financial counselor if the situation warrants.

 

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Patient Information

Patient's First Name * Patient's Middle Initial Patient's Last Name * Patient's Address 1 * Apartment/Unit City * State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY ZIP Code * Preferred phone * Patient's Email Address * Date of Birth * Gender Male Female Prefer not to answer Performance or Artistic Area Primary arts employer Position

Insurance Information

Health insurance plan name Health insurance type EPO HMO Medicaid HMO Medicare POS PPO Other Medical specialty preference

Preferred Houston Methodist location(s). Please check all that apply *

Texas Medical Center Baytown Clear Lake Cypress Katy/West Houston Sugar Land Willowbrook The Woodlands

Additional Information

Additional Information

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