Forms For NEW and Establish Patients

• Quality/Medical Excellence
  Our experienced Certified Pediatric Nurse Practitioners are board-certified by the Pediatric Nursing Certification Board and have trained in some of the top-rated pediatric hospitals in Houston.   
  
• Family Center Care
  We want our families to consider us a total resource for their child's healthcare needs. We are committed to continuity of care and we provide a comfortable, caring environment so our patients and their families can feel at ease. 
  
• Technology
  With rapid changes in technology, we strive to always incorporate the latest tools to allow patients easy and secure modes of communication.
  
• We are currently accepting new patients from newborn to 21 years of age. We look forward to becoming part of your family.

1. Read our Office Policy. Please review & sign our office policy form.

2.  Read Our Consent for Minor Form. Parents need to fill out the consent to treat a minor.

4. Read our Notice of Privacy Practices. The Notice of Privacy Practices informs you of the use of your child's health information in accordance with the Health Insurance Portability and Accountability Act of 1996, also known as HIPAA. 

The Consent Without Parent form should be completed  for all patients if someone other than the parent or guardian will be bringing your child to the office. The person bringing the patient must be at least 18 years of age and have a pictured ID. 
ALL PATIENTS MUST BE ACCOMPANIED BY A PARENT OR LEGAL GUARDIAN FOR THE FIRST VISIT- NO EXCEPTIONS.

1. Does your office accept insurance?
   Answer:  We do accept Commerical and Medicaid insurance plans. Please call us to find out if we are in-network with your insurance. 
2. Does your office see patients over 21?
   Answer: No. We are only licensed to see patients from birth to 21 years.