Kinder Haus Pediatrics Policies and Forms

Same-Day Sick Visit Appointments
Veteran Owned
Board Certified Pediatrics

New Patient Registration and Policy and Consent Forms

To save time, download and complete the necessary forms (please print)and bring them with you to the clinic on the day of your appointment. Printed copies can be provided at the time of your office visit if needed. Contact Kinder Haus Pediatrics for more information.

New Patient Registration Form

Consent to Treat Minor

Health History

Medical Record Release Form

Other Policies and Consent Form

Financial Policy

HIPAA Form

Other Commonly Used Forms

For your convenience, we provide these additional forms. If the forms are applicable to your child, please print and complete them prior to your appointment. You only need to complete the immunization registry once per child.

Immunization Registry Consent

Texas Sports Participation Form

Allergy and Anaphylaxis Emergency Plan

Asthma Action Plan

ADHD Parent Evaluation

ADHD Teacher Evaluation

Scouts Participation Form