This site requires Flash Player
Welcome to our practice

Thank you for choosing Mark D. Le M.D.,P.A. for your healthcare needs. On your first visit, we recommend to arrive 30 minutes before your scheduled appointment to complete the registration paperwork. Please have your insurance card(s) and a photo ID. Minors (under the age of 18) must have a parent present at their visit, or a letter stating that minor has permission to be seen without a parent, with parent’s signature and photo ID. If any of these items are not supplied at the time of the visit, you will be rescheduled.

In an effort to reduce check in time, you may log in to the Patient Portal to complete the registration or download the interactive forms to fill out, sign and date and fax to:

Hempstead Office fax: 979-921-0245         Tomball Office fax: 281-255-6335

Patient Forms

Patient Registration Form
Patient Medical History Form
HIPAA Privacy Practice Statement Form
Financial Policy Agreement Form
Notice of Privacy (for your records)

Self-Pay Patients

Self-pay patients are expected to pay in full at the time services are rendered.

Worker’s Compensation

For services related to on the job injuries and illness, Mark D. Le M.D.,P.A. will bill your employer’s worker’s compensation insurance carrier and follow all procedures as required by the worker’s compensation laws. Only when it has been determined that your injury or illness is unrelated to your work will we bill your health insurance or you.

Automobile and Other Liability Cases

Mark D. Le M.D.,P.A. cannot bill third parties in liability cases due to extreme delays of payment usually associated with such cases. We may bill your health insurance carrier or treat the rendered services as a self-pay patient and you can in turn submit the medical bills accordingly.


If you arrive more than 15 minutes late for your appointment, you may be asked to reschedule or you may have the option to be considered as a “walk-in” patient. This helps ensure that each scheduled patient can be seen in a timely manner. We request 24 hours notice on all appointment cancellations.

© 2010 Mark D. Le M.D.,P.A. Medical Clinic. | Disclaimer