Stonebridge Pediatrics, P.A.

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New Patient Registration

Interested in joining the practice? If you follow these directions carefully it will help to get a lot of the initial paperwork that is required to be done so that your first visit to our office will go much faster and smoother:

TIP For families with multiple children, we must have a complete set of the following documents for EACH child. To avoid have to re-type the forms for each child, save a copy of each document on your desktop. Then change the appropriate information that differs for each child (i.e. name, date of birth). Don't forget to print out and sign the documents for each child!

Click HERE to open the "Information Sheet." It is in MS Word format which can be filled out on your computer. Once it is filled out, print it, sign and date it.
Click HERE to open the "Initial History Questionnaire." It is also in MS Word format which can be filled out on your computer. Once it is filled out, print it.
Click HERE to open our Notice of Privacy Practices. Read and review this document. You will need a Adobe Acrobat Reader (free download here) to read it. If you have any questions, please contact our office manager/privacy manager who will be glad to help you.
When you have finished reading it and you feel you understand it, click HERE to open the acknowledgement of receipt document. Once it is filled out, print it, sign and date it.
Click HERE to open the Consent for Use & Disclosure of Protected Health Information. Please complete, date, and sign it and bring it with you to the office.
Click HERE to open the transfer of medical records document. It is also in MS Word format and can be completed on your computer. Once it is filled out, print, sign and date it.
Click HERE to open the office policies document. Once you have read it and you feel you understand it, please print, sign, and date it.
Click HERE to open the Immtrac registration form. This will allow you to look up your child's immunization schedule online.

Here is a summary of the documents needed on or before your first appointment:

Information Sheet

Initial History Questionnaire

Acknowledgement of Receipt of Notice of Privacy Practices

Consent for Use & Disclosure of Protected Health Information

Transfer of Medical Records Request

Office Policies Document

Immtrac registration form

A copy of the front of your driver's license and the front and back of your insurance card

All of the above documents can be mailed (175 Ridge Road, Suite 200, McKinney, TX 75070), faxed to 214-544-2550 or brought with you to your first appointment (in the future we will enable these documents to be submitted electronically). We prefer that you either mail or fax your documents to us. If we have your documents with enough time before your first appointment this will dramatically decrease the amount of time it takes for your registration. Thanks!