STEP 1 OF 2: New Patient Registration
This is Step 1 of 2 for New Patient Registration.

Within 24 hrs of completion, you will receive a HIPPA compliant, secure email (from HFAlerts@NEXTgen.com) for Step 2 of 2 of the Registration Process. Please complete both steps before contacting us to schedule your appointment.

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

If you have any questions, Call 469-333-1KID(543) or text 469-333-3211.
Email *
PATIENT FIRST NAME *
PATIENT LAST NAME *
PATIENT DATE OF BIRTH (IF EXPECTING, PLEASE USE MOM'S DATE OF BIRTH) *
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DD
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ADDRESS (PLEASE INCLUDE CITY AND ZIP CODE ) *
PHONE NUMBER *
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