All the Patient Forms are HERE
for Your Convenience

Patient Forms & Paperwork...no one likes it but it is the quickest way to get Dr. Hipke up-to-date with your teen's health.  Here all all the Adolescent Care Team Patient Forms for your convenience.

You can also get them by dropping by the office, mail or Contact Us.

When they are complete, you can bring them by the office, mail them or secure email them.

Before Your Teen / Tween is a New Patient...

You will need to fill out an 'I Want to Be a New Patient Form' and return it to the office.  Your teen will need to be accepted into the practice and have an appointment scheduled before you need to complete any other form on this page.

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New Patient Forms

...After your teen / tween has been accepted into the practice, please complete these forms prior to the day of the visit.  (You will have more paperwork on the day of the visit, so don't wait!)

New Patient Health History Form (pdf)

Patient Contact & Insurance Information Form (pdf)

Consent to Treat Form (pdf)

• The Consent To Treat Form refers to the HIPAA Privacy Policy and Patient Rights and Responsibilities Policy which do not need to be downloaded but need to be reviewed.
• If you wish to have your own personal copy of either, you can download the pdf version from their links above.

That's it!

Gather up your insurance card and shot record...and bring them to the New Patient Appointment.

Done!  See you soon.

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Other Useful Patient Forms

Sometimes Records may need to be obtained from other doctors / hospitals / clinics:

• Authorization to Obtain Medical Records from other Providers (pdf)

Sometimes Dr. Hipke's records may need to be sent to another clinic/ specialist / doctor:

• Authorization to Send Dr. Hipke's Records to another Provider (2 page Word Document)
• Learn more about Sending Medical Records to others here.
  

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Physical Forms

LInks to Common Physical Forms that patients bring to Dr. Hipke:

• Texas UIL Physical Form pdf
• Boy Scouts of America Physical Form (Go to 'Are you Going to Camp?" and Click the Download button)
  

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