New Patient Forms
New Patient Registration
Become a patient.
If you have previously been a patient at another clinic and would like to transfer care to NxT Step Pediatrics, you will need to fill out a request of medical records release form and submit a signed copy to your previous provider. Then we will be able to obtain your patient records.
Then, please complete the remaining forms to register with NxT Step Pediatrics. We are here to assist if you have questions!
We look forward to seeing you at our Frisco pediatrician office soon!
Click each link to complete and directly submit the HIPAA-compliant forms below.
All of the documents below must be completed.
***Please submit your child/children's vaccination records PRIOR to your appointment***
You can email them to email@example.com
- Patient Demographic Form
- Child Health History
- Patient Responsibility/Financial Agreement
- Consent to Treat & Prescription Policy
- HIPAA Form & Privacy Notice
- Wellness Care ACA
- Medical Release Form