’Click

Complete Registration Packet
Completed Health History
Insurance Card [primary and secondary, if applicable]
Drivers License / Picture ID for parents / guardians
Complete Immunization Records (first visit and each Well Child visit).
Initial Newborn Visit – Newborn record from hospital
If you do not complete the required paperwork before your office visit, please arrive 30 minutes before your scheduled appointment.

Well Child and Physical exams require:
~ Immunization records.
~ School / Sports / Camp / Scout Physical forms with parent information completed upon arrival for appointment.


Child Custody / Divorce Cases – It will be the responsibility of the parent or guardian that brings the child into the Clinic for treatment –
To bring a current insurance card to each appointment
To pay all co-pays, deductibles and balances on account. It is the parents’ obligation to work out an agreement between themselves or through the court system to share the cost of medical services for their children.

If you are unable to keep your child’s appointment, please call our office as soon as possible, preferably 24 hours in advance, to cancel and / or to reschedule. This policy helps us to offer appointment times as they are requested by all patients.
If you miss two appointments in a row without any prior notification, you will be charged $30. If you miss a third appointment, you may be subject to discharge from our practice.

Please let your physician / nurse know of any medication refills that you may need during the time of your clinic visit. If you are requesting a refill at other times, you may call your pharmacy first and they will fax us a request for approval.

Child’s name, date of birth, current weight
Name of current prescription medications – dosage, how often your child is taking it
Name, location and phone number of a 24-hour Pharmacy near you

Conroe Regional Medical Hospital
St. Luke’s Episcopal Community Medical Center – the Woodlands
Memorial Hermann Hospital – the Woodlands


If your child is assessed to be in an unstable condition, you will be directed to the nearest emergency facility for further evaluation.
If your child is in stable condition, you will be given an appointment at the first available time that day. If you cannot wait, you may make an appointment for a later time that day or for a different day.
