Patient Forms & Information
Please bring your current insurance card and current DL at every appointment.
The following forms may be downloaded and printed. Bring the completed forms to your appointment for a quicker check-in time.
Patient Registration Forms (6 pages) - New patients or patients whose information has changed should complete these forms. Please sign and date where requested.
Authorization to obtain medical records (1 page) - Complete, sign and date this form to allow Kids’ Doc to obtain medical records from your child’s prior physician.
Immunization registry - Minor Consent (2 pages) - Complete this form to register your child’s immunization records in the Texas Department of State Health Services Immunization Registry.
Texas Vaccines for Children - Patient eligibility Screening Record (2 pages) - Complete this form to verify your child’s eligibility for vaccinations.
Notice of Privacy Practices (7 pages) - Review this document to obtain complete information on our privacy practices.