Patient Forms, Map and Directions to Houston Office
Thank you for choosing Healthy Children Pediatrics as your child's medical home, where we always provide a comfortable, caring environment so our patients and their families can feel at ease. We've included helpful items on this page to ensure you and your child's first trip to our office is productive, stress-free and enjoyable.
Mission Statement
Our practice is working together to build life-long relationships between our staff and our patients by consistently providing our patients with compassion, excellence and value.
To fulfill this mission, we are committed to:
- Improving the lives of the children we serve by providing quality care in a child-centered environment.
- Listening to our young patients and their families who we are privileged to serve.
- Guiding our patients along a path of optimal health and wellness.
- Continually pursuing excellence at all levels through continuing education.
If you're preparing for your child's first visit, you can do a few things to help expedite the appointment. Please provide the following information when you arrive for your visit:
- Insurance and identification cards
- Complete immunization records
- Medical records from your previous pediatrician
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 Patients are able to submit their completed forms via email. Send all completed patient forms to [email protected].
- Patient Information Form
- Notice of Privacy Form
- Acknowledgement of Receipt of Notice of Privacy
- Immunization Registry minor Consent Form [English] | [Spanish]
- Pediatric Medical History Form
Immigration Medical Examination and Vaccination Record
1. Patient Information
2. Medical History Form (For Immigration Examination)
3. Notice for Female to Receive MMR Varicella Vaccines
COVID-19 Vaccine
In order to view or print these forms you will need Adobe Acrobat Reader installed.
Click here to download it.
The Initial Visit
Our compassionate Houston pediatricians do whatever it takes to make every visit to our office a pleasant, relaxed experience. With all of the important information about our practice available on our website, you can feel confident that you and child are well-prepared for your first appointment. We also invite you to review our staff page in order to get to know our doctors and staff. We look forward to meeting you.