Secure Patient Portal

Pay Your Bill Online

Facebook Instagram X-twitter Youtube Linkedin
New Patient Sign-Up

Pay Your Bill Online

Secure Patient Portal

Facebook-f Twitter Youtube Linkedin-in
New Patient Sign-Up

Forms

New Patients

All new patients must fill out patient information sheets. Please print the completed forms and bring them with you at your appointment.

Patient Registration and
Insurance Form

Print the form
Complete it online

Financial Policy
Agreement Form

Print the form
Complete it online

Receipt of Privacy Practices Notice Written Acknowledgement Form

Print the form
Complete it online

Records Release Form

Print the form
Complete it online

Patient Consent to Disclose Private Health Care Information HIPAA Form

Print the form
Complete it online

HIPAA:

We abide by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Please read this document to understand your rights under the HIPAA privacy rules:

HIPAA PDF Document
Complete it online

Records Release Form

Print the form
Complete it online

TELEHEALTH CONSENT:

Print the form
Complete it online

Records Release Form

Print the form
Complete it online

Existing Patients

Existing patients must complete the Patient Registration Form if there is any change in insurance or personal information. Please print the completed forms and bring them with you at your appointment.

Patient registration form

Print the form
Complete it online

Records release form

Print the form
Complete it online

Telehealth consent form

Print the form
Complete it online

Subscribe Newsletter Get Updates

Connect With Us

Facebook Instagram X-twitter Youtube Linkedin
At Lake Lewisville Pediatrics, we’re dedicated to providing compassionate, personalized care for every child. Whether it’s a checkup, vaccination, or same-day visit, our caring team is here for your family.

Contact Info

info@lakelewisvillepediatrics.com

(972) 315-8500

123 Lakeview Drive, Lewisville, TX 75057

Quick Links

Our Services

© 2025 Lake Lewisville Pediatrics. All Rights Reserved By – Design By Bmybrand