RECORDS & FORMS
There is a $25.00 charge for medical records. Please allow up to 15 days in order for us to have the records copied. There is no limit to the amount of records that we will copy. There is a $5.00 charge to print a copy of a shot record for a patient, this is why we encourage parents to bring in their child's shot records each visit. Call 468.6277 to request copies or you may fill out our online request.
There will be a $20.00 fee for filling out all FMLA paperwork, Medical Action Plan, or any other form which requires the doctor’s time to fill out or process.
Please take a moment to print the following forms prior to your first visit: the Patient Information Sheet and the HIPAA Signature Form. We have also included specialty forms that can be printed upon the request of your physician, patient information forms that you can view and read, and some informational pieces regarding immunizations.
Please contact us if you have any additional questions.
PATIENT FORMS - Please print
Patient Information Sheet
HIPPA Signature Form
Texas Vaccines for Children Eligibility Screening Record
SPECIALITY FORMS - Print upon request of physician
PATIENT INFORMATION - These are for your information, you do not need to print