New Patient Registration Form

Step 1 of 3 for New Patient Registration

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

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

We will send you a message through the Klara app, to complete the registration process and get your first appointment scheduled!

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

Text us at 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*