New Patient Forms

New Patient Registration

To become a new patient please complete the HIPAA-compliant forms below.

***MAKE SURE TO CHECK WITH INSURANCE TO VERIFY YOU ARE IN-NETWORK WITH THE DOCTOR BEFORE COMPLETEING ANY FORMS***

After forms are completed please send vaccine records to our email: hello@nxtsteppeds.com

(If you have any questions call us at (469) 447-8730)

  1. Patient Demographic
  2. Child Health History
  3. Patient Responsibility/Financial Agreement
  4. Consent to Treat
  5. HIPAA Form & Privacy Notice
  6. Wellness Care ACA
  7. Medical Release