We consider it a privilege that you have chosen Healthy Kids
Pediatrics as your child's primary medical home. Under the New
Patient Forms tab are the necessary paperwork needed in
securing your child(ren)'s first appointment. Please take note
of the date your paperwork is due back in our office in the email
you received. Please print out the paperwork, fill out the forms
completely and then scan and email them to:
email@example.com or fax them to
972-294-0809 ATTN: Chris Mendoza
We highly recommend that you save your forms to your desktop or
a hard copy in a folder. We have all had a document get lost via
email or fax and we would hate for you to have to fill out the
forms a second time as we do understand they are lenghty.
We look forward to meeting you and your
child(ren). Please note: Healthy Kids
is not a provider
for Medicaid, Amerigroup, CHiPs or Medicare.
See you soon!
Print or Save
Please read, review and print or save to your computer our policies for your own records.
You will be asked to sign an acknowledgement (below) that you have received these policies. If you prefer, copies of the policies are available in our office,
Print and Sign
Please complete the forms, print, sign and fax to our office. New patient paperwork and records request must be received
before an appointment can be made. If you prefer to email your forms, call the office and we will send you a secure email link.
Adobe Reader is Required
These forms use Adobe Reader to allow you to download, edit and submit electronically. If you are not able to submit or edit a form, be sure you have a current version of Adobe Reader installed.
Some forms are large. Please be patient while each form downloads, opens and submits.
We care about your privacy. These secure forms are not sent via email, but are uploaded securely to our server where they are accessed by Healthy Kids Pedicatrics staff and added to your patient file.
Form Help & Instructions