Contact Us

Contact UsDr. Alexander Mantas2020-07-13T21:06:24+00:00

Main Office
12200 Park Central Drive
Suite 403
Dallas, Texas 75251

Endoscopy Center
9500 N. Central Expressway
Suite 200
Dallas, TX 75231

Hospital GI Lab
7777 Forest Lane
Suite 242
Dallas, TX 75251

Contact Form

Dr. Alexander Mantas’ Certifications

Full Legal Name

Gender

MaleFemale

Date of Birth

Email Address

Home Phone Number

Mobile Phone Number

Office Phone Number

Prior GI Work Up

YesNoNot Sure

Select Requested Procedure(s)

If Yes, please briefly describe your work up including all previous procedures and their dates and the gastroenterologist who treated you.

Referring Doctor (If Self Referral, Please Type "Self")

Primary Care Doctor

Primary Insurance Provider

Reason For Office Visit

Disclaimers

I understand that if any of the insurance information I have provided is incorrect or if I fail to notify the office of any insurance changes that I am responsible for all physician charges and non-covered medical services.

I hereby authorize the release of any medical information necessary for the process of insurance. I hereby assign all medical and/or surgical benefits to include major medical benefits to which I am entitled to Alexander Mantas, MD, PA, Digestive Health Associates of Texas, PA and Digestive Health Management Endoscopy Centers. This assignment will remain in effect until revoked by me in writing. A photocopy of this agreement is to be considered as valid as an original. I have received the Notice of Privacy Practices.

By Submitting This Form, Patient Agrees To All Terms, Conditions & Disclaimers!

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Contact Us

Contact Us

Main Office
12200 Park Central Drive
Suite 403
Dallas, Texas 75251

(214) 617-2000

Endoscopy Center
9500 N. Central Expressway
Suite 200
Dallas, TX 75231

(214) 739-9544

Hospital GI Lab
7777 Forest Lane
Suite 242
Dallas, TX 75251

(972) 566-7089

Contact Form

Dr. Alexander Mantas’ Certifications

Appointment Request

Full Legal Name

Gender

Date of Birth

Email Address

Home Phone Number

Mobile Phone Number

Office Phone Number

Prior GI Work Up

Select Requested Procedure(s)

If Yes, please briefly describe your work up including all previous procedures and their dates and the gastroenterologist who treated you.

Referring Doctor (If Self Referral, Please Type "Self")

Primary Care Doctor

Primary Insurance Provider

Reason For Office Visit

Disclaimers

By Submitting This Form, Patient Agrees To All Terms, Conditions & Disclaimers!

Security Question

Translate:

Contact Us

Contact Us

Main Office 12200 Park Central Drive Suite 403 Dallas, Texas 75251

(214) 617-2000

Endoscopy Center 9500 N. Central Expressway Suite 200 Dallas, TX 75231

(214) 739-9544

Hospital GI Lab 7777 Forest Lane Suite 242 Dallas, TX 75251

(972) 566-7089

Contact Form

Dr. Alexander Mantas’ Certifications

Appointment Request

Full Legal Name

Gender

Date of Birth

Email Address

Home Phone Number

Mobile Phone Number

Office Phone Number

Prior GI Work Up

Select Requested Procedure(s)

If Yes, please briefly describe your work up including all previous procedures and their dates and the gastroenterologist who treated you.

Referring Doctor (If Self Referral, Please Type "Self")

Primary Care Doctor

Primary Insurance Provider

Reason For Office Visit

Disclaimers

By Submitting This Form, Patient Agrees To All Terms, Conditions & Disclaimers!

Security Question

Translate:

Main Office
12200 Park Central Drive
Suite 403
Dallas, Texas 75251

Endoscopy Center
9500 N. Central Expressway
Suite 200
Dallas, TX 75231

Hospital GI Lab
7777 Forest Lane
Suite 242
Dallas, TX 75251