New Patient Registration Form

Step 1 of 3 for New Patient Registration

Step 1 – You are Here

Please complete the following form for each of your children with each child registered individually.

Step 2

Within 48 hours, you will receive a secure, HIPAA compliant email from hfalerts@nextgen.com to create your patient portal login and e-sign your registration documents.

Step 3

Send us a message through the Klara app, or directly text us at 469-382-3440 to complete the registration process and get your first appointment scheduled!

*To register multiple children, please register each child individually*

Still need help?

Watch this video for step by step instructions: https://youtu.be/Ti-B474Kp-I

If you have any questions, Call 469-333-1KID(543) or text 469-382-3440

Email*

Patient First Name*

Patient Last Name*

Patient Date of Birth (If expecting, please use mom's date of birth)*

Location*

Appt Type

Street Address

City

State

Zip Code

Phone Number*