STEP 1: NEW PATIENT REGISTRATION
Email *
**** PLEASE NOTE THIS PROCESS IS NOT COMPLETE.***** YOU WILL RECEIVE A HIPPA COMPLIANT, SECURE EMAIL TO FINISH REGISTERING YOUR CHILD. PLEASE FULLY COMPLETE THIS PROCESS BEFORE CONTACTING US TO SCHEDULE YOUR APPOINTMENT.
*******The hippa compliant email you will receive in your inbox, will come from HFAlerts@NEXTgen.com within the next 24 HRS.

-Please enter the remaining demographic fields and create a patient portal login.
-Please login with your username and password to finish the New Patient Registration.
-Call us to schedule your appointment.

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

CALL: 469-333-1KID (543)
TEXT:469-333-3211
PATIENT FIRST NAME *
PATIENT LAST NAME *
PATIENT DATE OF BIRTH (OR EXPECTED DUE DATE) *
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ADDRESS (PLEASE INCLUDE CITY AND ZIP CODE ) *
PHONE NUMBER *
Will you be seeking care from one of our off-site Satellite clinics such as: Vibrant Life Chiropractic, T3 Chiropractic or Center for Holistic Healing? **Only answer yes if you are currently being seen at one of these offices and are establishing care with Shine Pediatrics and Wellness Center *
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