Forms & Paperwork

Registration / HIPAA Forms

NOTE: New patient forms as well as requests for medical records can also be done using our online Patient Portal. New Patients click here.   No need to print or fax!

 

New Patient Packet
All new patients must fill these out. Save time by printing and filling them out before your first appointment. You can bring them in with you, or fax them to (512) 828-0451.

Pre-Natal Forms
Fill out this form for your pre-natal visit with the doctor.

Medical Consent Form
Use this form if you need a friend or family member to bring your child to the doctor. We cannot see your child without your written consent. (En Español)

Shot Records / Lab Work Request Form
If you need a copy of your child’s immunization records, we can provide one, free of charge within 24 hours. Call ahead or fax us this form with instructions on where to send them (school, home, etc.) A copy of Complete Medical Records can be picked up or mailed. There is a $10 processing fee for each child for Complete Records. Please allow up to 48 hours for Complete Medical Records. You will be asked to fill out the above form in order for us to release the records.

Medical Records Transfer
Use this form to authorize your previous doctor’s office to send us your child’s medical history. Your old office may charge a fee for medical records.

Well Check Questionaires  (Ages and Stages Questionnaires)

For Well Checks 2 months – 5 years

Brookes Publishing will not allow us to post the questionnaires online due to copyright issues, so if you would like the ASQ forms privately sent directly to you before the appointment please call the office at (512) 255-7337.

Thank you.

Downloadable Forms:

Well Check 6 – 12 years

TEEN questionnaire – 13 – 18 years (for the teen to fill out)

PARENT of TEEN questionnaire – 13 – 18 years