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New Patient PacketNew Patient forms must be completed PRIOR to your appointment. Forms may be downloaded below or completed on the Patient Portal. You may also stop by our office and pick up a packet. New Patient forms, along with your insurance card and ID, can be easily uploaded to the Patient Portal at yourhealthfile.com by selecting "Review Medical Records" and then selecting "Amend My Records". Please contact us for a link to register. ALL PATIENTS MUST BE ACCOMPANIED BY A PARENT OR LEGAL GUARDIAN FOR THE FIRST VISIT- NO EXCEPTIONS. Feel free to email (info@premierpediatricshouston.com) or fax (281-306-5100) your completed forms prior to your appointment date.
English New Patient Welcome Packet English New Patient Forms Spanish New Patient Welcome Packet Spanish New Patient Forms In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it. |
Consent Without A ParentThe Consent Without Parent form should be completed for all patients if someone other than the parent or guardian will be bringing your child to the office. The person bringing the patient must be at least 18 years of age and have a pictured ID.
ALL PATIENTS MUST BE ACCOMPANIED BY A PARENT OR LEGAL GUARDIAN FOR THE FIRST VISIT- NO EXCEPTIONS. English/Spanish Consent Without Parent |
OTHER IMPORTANT
DOCUMENTS & POLICIES
Release of Medical
Records Form This form is needed to retrieve medical records from your previous provider or for us to release records to another provider, daycare, or school. English Spanish No Show Policy It is our goal to provide timely and convenient service to each family. In the event that you will be more than 15 minutes late, please call our office as soon as possible. At that time, our staff will advise you whether the patient can still be seen or will need to be rescheduled for the next available appointment. It is unfair to others if you do not show up for your appointment or arrive late without advance notice. There will be a $25.00 No Show fee if you fail to notify us at least 4 hours prior to your scheduled appointment. We offer same day sick appointments. If you walk in without an appointment, there is no guarantee that you will be seen. However, we can offer you the next available appointment to guarantee you an appointment time. |
Vaccine Policy
We feel strongly that vaccinating children on schedule with currently available vaccines is absolutely the right thing to do. However, should you have doubts, please discuss these with us prior to your visit. We may slightly alter the schedule. If you absolutely refuse to vaccinate your child, we ask that you seek care with a provider who shares your views. Refill Requests
Refills are generally available for medications used for ongoing conditions such as allergies, eczema (other than steroids), and reflux. Refills are not available for antibiotics, albuterol, or steroid creams without an appointment. Refill requests for non-emergency medications will be handled within 48 hours. Medication refills must be handled through your pharmacy. Please call your pharmacy and initiate a refill. If the medication requires a refill authorization, advise your pharmacy to send an electronic refill request (not a fax). Medication Requests are not handled after hours. The after-hours service does not have access to your child's medical records. |
Privacy Policy
This notice describes how medical information about your child may be used and disclosed and how you can get access to this information. Please review it carefully. Telephone Triage & After Hour Calls
Our clinical staff is available to discuss concerns you have regarding your child. They have been instructed on specific information to give about common pediatric illnesses and will consult with Dr. Knight prior to giving advice if there is an unusual problem. Whenever possible, we ask that calls requesting medical advice be made when the office is open and our staff has access to your child’s medical records. If an urgent problem arises and you cannot wait for the office to open, you may call after hours to speak with a nurse for medical advice that has been approved by Dr. Knight. Medications can not be called in after hours. Appointments can not be made after hours. |