Bhargav Trivedi, M.D.
Child Care Pediatrics, P.A.

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New Patient Paperwork

 

Medical Release Form

 

Immtrac Release Form (Texas vaccine registry)

 

HIPPA Privacy Policy (for review only)

 

New Patient Paperwork (Spanish)

 

 

HIPPA (Spanish)

Patient's coming to our office for the first time are asked to bring the child's insurance card and immunization record. We will also need a parent/guardian to complete the new patient paperwork, medical release form and Immtrac release form. The HIPPA privacy form is available for review below.