Patient Forms

Beginning Sept. 1, 2011, there will be a $10 charge for forms which are not provided to MDPA at the time of the patient’s visit.  If a letter is needed, there will be a $30 fee.   

New Patient Registration

The first step to becoming a patient is to register on PatientLink. Creating an online account only takes a few minutes. Here’s how:

  1. Click “Create a new account.”
  2. Enter in your child’s information and an e-mail address, then click “Create my account.”
  3. You’ll also be asked to enter your contact information, choose your preferred location and create a username and password that you’ll need to access your online account. Then click “Join MD Pediatric Associates .”
  4. You’ll see a “Patient Information” page. When you click “Save and submit,” this information will be electronically entered into our system.
  5. Repeat these steps for each child you want to register. Hint: Use the same password for all accounts.

In addition to creating an account, you’ll need to complete the following forms:

  • HIPAA Privacy and Security Policy Receipt PDF
  • MD Pediatric Associates Financial Policy Receipt PDF

Bring these to your child’s first appointment, or fax them in advance to our office at (469) 671-5437.

Download Adobe Acrobat Reader for free at http://get.adobe.com/reader/.

You can be assured your information is secure in PatientLink. The online system is maintained by MedFusion, but only MD Pediatric Associates receives and securely stores your personal and financial information.