Download Forms
We have provided the following forms for our patients. You can quickly and conveniently download these office forms. Please bring your completed forms into the office at the time of your visit.
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- MEDICAL RELEASE FORM
- New Patient Registration
- ADHD Vanderbilt Parent & Teacher Assessment Scale Forms
- Pregnancy Conference
- SPORTS PHYSICAL FORM
- HIPPA – Notice of Privacy Practices
Insurance Information
Heart of Texas Pediatrics participates in the following insurance plans:
Accountable Health Plan
Aetna
Affiliated Healthcare
BCBS Blue Choice
BCBS Par Plan
Beech Street
Blue Bell Creameries
Brazos Valley Network
ChoiceCare Network (HMO)
Cigna-BVN
Definity Health
First Care/Southwest Health & Life
First Health
Galaxy Health Network
Great West Healthcare
Healthsmart
Humana PPO
Humana/Military
MCD/TAX ID
MCD/Healthsteps/TAXID
MCR DME
MedCorp Southwest
Multispan/BCE Emergis/Admar
PHCS
PPO Next
Principal Life Ins
Pronet/Aetna/TRS (Teacher Retirement System)
Providence Health Alliance
Scott & White
Superior Health CHIP
Texas Municipal League
Texas True Choice
Tricare
Unicare
United American
United Healthcare
USA MCO PPO
Wells Cargo/Caresource
If your insurance is not on the list, please call your insurance company to see if we are a provider. We accept most insurances. Always make sure your policy covers preventive care, including well-child visits and vaccines. You are responsible for any services not covered by your insurance company.
WELL AND SICK VISITS AT THE SAME TIME
Your insurance company may cover well and sick visits differently, and it is very important that you familiarize yourself with the details of your insurance coverage. No one likes being surprised with a bill! While some insurance may pay for well visits 100% (where there is no cost to you), sick benefits may include a co-pay, co-insurance, and/or a deductible. If during a well visit your child is sick or has an issue that is not related to the normal growth and development of your child, and he/she needs treatment and/or medical attention for your concerns, your provider may bill the insurance company for both services. Regardless of whether there is a no charge for the well visit, you will be responsible for any charges passed on to you for any treatments and/or care given not covered.
Prescription Refills
For refills, please first contact your pharmacy first. If no refills are available, the pharmacy will send a request to our office. Refills on antibiotics generally will not be approved. An appointment will need to be scheduled. For refills on controlled substances such as ADHD medications, please contact us 24 hours in advance. We may require a recent office visit for refills on medicines for chronic conditions such as asthma and seizures.