At Texas Children's Pediatrics Katy, our goals are to promote well-being through preventive medicine and anticipatory guidance, provide appropriate treatment for acute illness and offer insight for optimal management of chronic disease.
New patient paperwork
Please complete and send in the following forms, along with a copy of the front and back of your insurance card, to firstname.lastname@example.org or fax them to 832-825-8880.
- Notice of privacy practices - explains the privacy rights of patient medical records
- Acknowledgement of privacy practices - indicates that the Notice of privacy practices was made available to you
- Patient financial policy - explains the policy for payment of services
- Texas Vaccines for Children (TVFC) patient eligibility screening - determines whether your child is eligible for TVFC. If your child is qualified for TVFC, please sign and date.
- TXDSHS immunization registry consent form - allow the State of Texas to have an electronic copy of your child's immunization record. If you consent, TXDSHS can replace your child's immunization records if they are lost. If you do not consent, please sign and date.
After an appointment, our physicians will write, call or fax in prescriptions. Our office may be called for routine prescription refills.