UIL Sports Form | TAPPS Sports Form | Dosage Charts | New Patient Forms

Car Seat Safety | Vaccine Information | Patient Education | Travel Health

Forms

We are happy to provide our office forms here for convenient download on your home or work computer. Please print and complete the appropriate forms, and bring them with you when you visit us. Our courteous office staff is happy to help you determine which forms you need. Please call us if you have any questions!


To view these files you must have Adobe Acrobat Reader installed on your computer.

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Patient Registration Form
For new patients and updated annually for established patients.
(You may complete a printed copy OR complete digitally using Adobe Acrobat Reader and use the handy button at the end to email it to us!)

Office Policies
Please read and sign the acknowledgement on the second page for your first visit.

HIPAA Privacy Policy
For your personal review.

HIPAA Acknowledgement Form
For new patients to be signed after the HIPAA Privacy Policy has been read.

Appointment of Agent
Please complete and sign to allow another adult to bring your child for a visit if needed.

Release of Medical Records
Please complete and sign to allow us to request medical records from another care facility or office.

Consent to Release Health Information
Please complete this form to allow us to leave phone messages regarding your child’s health care, as well as specifying with whom we can leave this information (other family members, etc.).

Developmental Screens - Ages & Stages Questionnaires
A chance to play with your child and check developmental milestones! Please bring a completed Ages & Stages Questionnaire (ASQ) for the appropriate check up visit. A copy of the Modified Checklist for Autism in Toddlers (MCHAT) is included with the 24 month questionnaire. Each file is password protected for copyright purposes: please contact our office for the password if you are an established patient in our practice.
Sports Physical Forms
Below you can download a copy of the University Interscholastic League (UIL) or Texas Association of Private and Parochial Schools (TAPPS) sports physical forms. Both forms are fillable PDFs, so feel free to digitally fill them out, print, and bring to your check up!
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Patient Education

We have found that these handouts contain very useful and reliable information for common medical problems and questions. We hope you find them helpful, perhaps on those sleepless nights when they may be most needed. As always, do not consider these materials a substitute for a good conversation with your doctor - we are always happy to help!

With many of the conditions discussed in the handouts below, fever management is important. You can look up proper dosing of acetaminophen and ibuprofen in our dosing sheet below, as well as appended to the Fever Management handout.

Acetaminophen and Ibuprofen Dosing Sheet

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