To facilitate your initial visit with us, please print & complete one of the first two new patient packets depending on whether or not your child is a newborn (age less than 30 days).
Please bring the completed forms with you. In addition, if your child has already received any immunizations, please bring your child’s immunization (shot) record. We look forward to seeing you!
7pgs includes: Patient Info, Health Info Privacy, Financial Policy, Pediatric History, Med Record Release & ImmTrac Reg’n
To request your child’s previous medical records from a physician, group, clinic, or hospital be sent to Hometown Pediatrics
To request your child’s medical records from Hometown Pediatrics be sent to an alternate physician, group, or health agency
**Effective October 10, 2013, Hometown Pediatrics will change our medical records policy in accordance with the legal guidelines provided by the Texas Medical Board and Texas Medical Association. We will provide a medical summary, which will include the immunization records, at no charge. If you are requesting complete detailed medical records there will be a charge of $25.00 for the 1st 20 pages and $0.50 per page thereafter. This will include any records sent to another facility if Hometown Pediatrics is not referring the patient. Thank you for your understanding.
For the parents or legal guardians wishing to grant permission for another adult to make health care decisions for their minor(s)