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Forms

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Forms

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Forms

Below are commonly used forms by our Springtime Families

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New Patient

  • Registration Form
  • Initial History Questionnaire
  • Protected Information Privacy & Security (HIPPA)
  • Acknowledgment of Receipt of HIPPA
  • Consent Form and Financial Waiver - unfortunately, insurers don't always keep pace with AAP guidelines, but we believe strongly in these recommended screenings
  • Financial Policy
  • Vaccine Policy
  • Transfer Form - use this to obtain permission to have your medical records sent to us.

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  • Initial Assessment Parent Form
  • Follow-Up Parent Form
  • Minor Permission Form - use this to obtain consent to accompany a minor patient
  • Initial Assessment Teacher Form
  • Follow-Up Teacher Form

ACCOMPANY A MINOR

  • use this form to obtain consent to accompany a minor patient

sports

  • Sports Physical Form

COVID FORMS

  • COVID Consent Form
  • What to Expect After Getting the COVID Vaccine
  • COVID 5-11 Years Fact Sheet

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Paper Forms


TIMINGS

Monday – Wednesday: 8:30 AM – 7:30 PM

Thursday & Friday: 8:30 AM – 5 PM

Saturday: 9 AM – 4 PM

Sunday: Closed


23530 Kingsland Blvd., Suite 100

Katy, TX 77450

(832) 844 – 1470

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© Springtime Pediatrics 2022

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Built by Fatima Razvi