Patient Forms

New Patient Forms

To make your appointment experience as smooth as possible please print and complete the New Patient and Health History forms and bring them with you to your appointment.

Well Child Information

Your child's health is our number one priority. We strive to provide you with resources and information you will find helpful.

General Information

*Ages and Stages (what to expect, nutrition, breastfeeding, potty training)
*Healthy Living,
*Safety and Prevention,
*Health Issues,
*Family Life
and much more please go to the following link.

* A copy of the Notice of Privacy Practices is available for your review when you visit the office.

Important Clinic Update

Effective 3/15/2024 we have retained Cariend, a medical records custodian, to manage the records for the next 25 years. Cariend is not a medical provider and does not handle billing, medications, or referrals for the closed practice.

Requestors should be prepared to complete the Records Release Authorization Form and provide a copy of government-issued photo ID, as required by HIPAA. The fastest way to process requests for copies of medical records is to visit Cariend’s website and submit your contact information at the link below – you will then be sent an email with instructions to securely upload your authorization form and ID: https://www.cariend.com/request-records

If you do not have access to a computer or internet, Cariend can be reached by phone at 404-991-7080 – please note the HIPAA laws do not allow medical records to be released based on aphone or email request.If you prefer to mail your completed Authorization Form and Government-issued Photo ID:

Cariend ROI

PO Box 1866

Thomasville, GA 31799-1866

If you have questions about the process, Cariend can also be contacted via email at Request@Cariend.com however, you should not send sensitive personal information or request documents through email.

Important Clinic Update

Effective February 11, 2024, we have decided as a group to join Memorial Hermann Health System which will change our practice name to Children’s Memorial Hermann Pediatrics Conroe (CMHP Conroe). We will continue to see patients at our River Pointe office.

During this transition, the office will be closed from February 12 to February 16. We will strive to make this transition as smooth as possible. Beginning February 19, during your first visit back to our office, you will be asked to complete new patient paperwork and provide your ID and insurance card so your information can be entered into the Memorial Hermann records system. We thank you for your patience during our transition.

We will remain in network with most of the plans we are currently enrolled with (Aetna, Blue Cross, Cigna, Community Health Choice, Humana, Tricare, United Healthcare). If you have any questions please contact the office.

We look forward to seeing you at CMHP Conroe.