Patient Forms

We are happy to provide our office forms for convenient download on your home computer. Please print and complete the forms below, and bring them with you to your child's appointment. Questions about which forms you need? Please call our office and our courteous staff will assist you in preparing for your child's visit.

New Patient Forms:

Please complete the four forms below and send to our office via email at [email protected] or by fax 281-485-9469.

• Family Registration Form 
• General Consent to Treat Form
• Patient Portal Registration Form
• Medical Records Release Form

18 + Demographic Form:

• Adult Registration Form (18+ Years Old)

Office Policies:

• Notice of Privacy Practices
• Financial Policy
• Office Policy
• PCMH Patient Brochure
• Code of Conduct
• Divorce/Separation Policy

Assessment Forms:

• Vanderbilt Assessment - Parent (Initial)
• Vanderbilt Assessment - Parent (Follow up)
• Vanderbilt Assessment - Teacher (Initial)
• Vanderbilt Assessment - Teacher (Follow up)

Other Forms:

• Parent Flu Waver Form
• COVID-19 Pfizer EUA

In order to view or print these forms you will need Adobe Acrobat Reader installed.
Click here to download it.