We are excited that you have chosen Southlake Pediatrics, Inc. for your child's medical care. Your comfort and convenience are our priority, and we strive to make every visit to our office a positive experience. To help you get acquainted with our office and first visit procedures, we have included helpful information on this page.

Our Mission

Our practice is working together to build life-long relationships between our staff and our patients by consistently providing our patients with compassion, excellence and value. To fulfill this mission, we are committed to:

• Improving the lives of the children we serve by providing quality care in a child-centered environment.
• Listening to our young patients and their families who we are privileged to serve.
• Guiding our patients along a path of optimal health and wellness.
• Continually pursuing excellence at all levels through continuing education.

Patient Forms

To expedite your first appointment, please arrive a few minutes early to complete registration forms so that we have all the necessary information to treat your child. You may also download and print the forms from this website, fill them out ahead of time, and bring them with you to the first appointment.

DEMOGRAPHIC FORM

COMMUNICATION AUTHORIZATION FORM

• Children 0-13 years old (parent must fill out)
• Children 14 years & older (patient must fill out)

ACKNOWLEDGEMENTS AND PERMISSION FORM

SOUTH LAKE PEDIATRICS POLICIES AND PROCEDURES

NOTICE OF PRIVACY PRACTICES

SOUTHLAKE PEDIATRICS VACCINE POLICY STATEMENT

WELL CHILD APPOINTMENT FORMS

SCHOOL MEDICATION FORM

• Medication form (print all but prescriber authorization section & sign)

SPORTS PHYSICAL EVALUATION FORM

• Page 1 (print, fill out completely & sign)
• Page 2 (print & bring to your visit)

(If you're in college, each school may have their own form that needs to be filled out. Please check with your college and make sure that you are prepared with the form that they will accept)

ADD/ADHD EVALUATION FORMS

• Behavior/School Evaluation Form for doctor visit (fill out form except for Physical Examination section)

In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.

What to expect

A pleasant, comfortable first visit builds trust and helps put the child at ease during future visits. We want your child to enjoy getting to know our doctors and staff, so we work hard to establish this bond during every appointment to our office. During your initial appointment, we will explain everything in detail and answer any questions you may have.

We look forward to meeting you and your child and providing the quality, comprehensive medical care you expect and deserve.