New Patient Registration Form

Step 1 of 3 for New Patient Registration

***
EFFECTIVE UNTIL 04/01/2025
Shine is not accepting Integrative patients at this time, registration for Integrative patients will resume in April 2025.

This includes Autism, ADD/ADHD, Sensory Processing, Behavioral/Mood Problems, PANS/PANDAS, Asthma, Chronic Skin Issues/Eczema, Chronic GI concerns, or any other chronic issue that has lasted 4 weeks or more.

If your child has Integrative concerns, please check back with us in April to start the registration process
***

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.

Step 3

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*

Still need help?

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*