top of page
4909 Golden Triangle Boulevard, Suite 231,
Fort Worth, TX 76244
PATIENT PAPERWORK
OUR POLICIES AND PATIENT INFORMATION
White Cloud Pediatrics are dedicated to providing exceptional care for you and your children.
To help you get started, we’ve compiled important information about our practice policies, immunization guidelines, and forms for new patients.
Our goal is to foster a positive relationship by ensuring transparency and making the process as smooth as possible for your family.
ESTABLISHED and NEW PATIENT PAPERWORK
(Please fill out all forms)
Patient Information
Preferred Method Of Communication & Non Parental Consent To Medical Treatment
Consent To Treat Minor & Clinical Document Exchange Consent
Credit Card Authorization
Waiver Of Assignment Of Benefits
NEW PATIENTS ONLY
Choose the relevant form to complete, PLUS the authorization release form
Texas Immunization Registry
bottom of page