Forms

To save time on your first visit, please fill, print, then sign the following forms:

NEW PATIENT REGISTRATION FORM (ENGLISH, SPANISH)

ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY PRACTICES (ENGLISH, SPANISH)

TVFC PATIENT ELIGIBILITY SCREENING RECORD (BILINGUAL)

TDH IMMUNIZATION REGISTRY - IMMTRAC (BILINGUAL)

 

Print the following forms and read before your appointment:

NOTICE OF PRIVACY PRACTICES (ENGLISH, SPANISH)

OFFICE POLICIES (ENGLISH, SPANISH)

PAYMENT POLICIES (ENGLISH, SPANISH)

Office Policies

We do our very best to be available to see your child whenever you need us.  Please don’t hesitate to call as our staff is eager to help.


We work hard to ensure that your child receives prompt medical care in a comfortable, child-friendly office setting. To help expedite the first appointment, we ask that you please bring your child's immunization records and be prepared to complete paperwork regarding your family medical history, your child's medical history, and insurance information.


We see patients on an appointment basis and request that you call in advance so we may schedule one for you. If you are unable to keep an appointment, please call at least 2 hours in advance to cancel or reschedule. This is extremely important, and allows other children to utilize this time.


Please bring your child’s insurance card and shot record to every visit.


Please arrive 15 minutes prior to your appointment time to allow for insurance verification.

 

 

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