Pecan Tree Pediatrics

Patient Forms

New Patients

Please feel free to download, print, and fill out the following forms prior to your appointment.  Bring these forms to your initial visit or to update your records to expedite your check-in.

• Consent for Treatment
• Patient Registration Form
• Health History Form
• Financial Policy
• Privacy Practices Acknowledgement Form

 

All Patients

At any time, you may read and download a copy of our Privacy Practices.  A copy of this document will be provided to you at our office at any time upon request.

• Privacy Practices

 

Sick Visits

So that we can better address your concerns at your child’s sick visit, we have a form to help us understand the symptoms your child is experiencing. You may download, print, and complete this form prior to your visit.

• Sick Visit Form

 

Medical Release

Please allow 5 business days to complete your request for Medical Records.

• Requesting Pecan Tree Pediatrics Medical Records
• Releasing Records to Pecan Tree Pediatrics

 

Vaccine Refusal

At Pecan Tree Pediatrics, we advocate and encourage fully immunizing your child on the schedule recommended by the Centers for Disease Control.  However, in the case your family chooses to not vaccinate in a timely manner or at all, we require a Consent for Refusal to be signed by the child’s parent or guardian.

• Vaccine Refusal Consent Form
• Vaccine Exemption FAQs