All the Patient Forms are HERE
for Your Convenience

Patient Forms & 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...

Graduate your teen / tween to Longview's only medical clinic dedicated to teen care.

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.

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)

That's it!

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

Done!  See you soon.

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:

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)

› Patient Forms

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From teens: "I want to say thank you for all you've done to help me since the day I met you..."

From Parents:  "You've been a great example for my sons..."


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How to Add a Shortcut Icon to Your Mobile Device Home Screen!

While visiting our website in your browser, click BookMark.

You will get an option to 'Add Shortcut to your Home Screen'

Click Yes

Rename the Icon to 'Dr. Hipke' or 'ACT'.

Like magic, now you can find Dr. HIpke with one click!