Patient Forms

Print and fill out your child(s) registration form. Once you print and fill out your form you may fax it attention:

Medical Records - (956) 425-9207 or drop it off at our clinic (321 S 21st Street).

PDF icon HPA Registration Form: Want to make your registration process quicker? Print and fill out this form and have it avilable on your visit. PDF icon HPA Vaccination Schedule: List of vaccines that are recommended by the American Academy of Pediatrics.
PDF icon Medical Records Consent Form: Need to transfer your records to our clinic? Print and fill out this form. PDF icon HPA Policy: Our clinic's Financial Policy.
PDF icon TVFC Form: Texas Vaccines for Children Program Patient Eligibility Screening form.
PDF icon ImmTrac Newborn Registration Form PDF icon ImmTrac Texas Immunization Registry Consent Form (Minor)
PDF icon ImmTrac Recien Nacido Formulario de Registro PDF icon ImmTrac Formulario De Consentimiento Para Menores