New Patient Forms

Please complete and submit the forms below to register your children as patients at Pediatric Associates of Dallas.

New Patient
Registration Form

In order to comply with Federal Health Insurance Portability and Accountability Act (HIPAA) regulations, effective April 14, 2003, every family will be required to complete the new registration forms for our records.

New Patient
Registration Form

Patient History
Questionairre

Parents are encouraged to fill out an initial Patient History Questionnaire for each child prior to their first visit in our offices. Please bring the form along at the time of your visit.

Patient History
Questionairre

Office and
Financial Policies

The primary goal of our practice is to provide the best pediatric care to the children and young adults in our community. Since our practice has obligations that must be met, we ask that you agree to abide by our payment policies.

Office and
Financial Policies

DALLAS LOCATION

7859 Walnut Hill Lane #200 Dallas, TX 75230

Main: 214-369-7661
Business: 214-369-3303
Fax: 214-369-2328

office hours

MONDAY – FRIDAY
9 AM – NOON
2 PM – 5 PM
6 PM – 9 PM

SATURDAY
9 AM – NOON

PLANO LOCATION

5800 Communications Pkwy., Bldg. #1 Plano, TX 75093

Main: 214-369-7661
Fax: 972-378-6702

office hours

MONDAY, TUESDAY, THURSDAY
9 AM – 8 PM

WEDNESDAY, FRIDAY
9 AM – NOON
2 PM – 5 PM

SATURDAY
Dallas Office Only

New Patient Forms

New Patient Registration Form

Patient History Questionairre

Office and Financial Policies

DALLAS LOCATION

office hours

PLANO LOCATION

office hours

New Patient
Registration Form

Patient History
Questionairre

Office and
Financial Policies