Patient Forms

Request for Medical Records

For TLC Surgery patients requesting their medical records to be released to another doctor’s office, please download and complete the form below.

Once completed, the form can be emailed to MA@tlcsurgery.com or faxed to (281) 971-4065.

Download Form

Request for FMLA/Return to Work

For TLC Surgery patients that require FMLA paperwork be submitted or are requesting a letter to return to work after surgery, please email FMLA@tlcsurgery.com with the following information:

  • Patient’s name
  • Patient’s Date of birth
  • Date of surgery
  • Dates the patient has requested to be off from work
  • Date of anticipated return
  • Any special accommodations that TLC staff should be aware of when completing the request

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