Lake Pointe Pediatric Associates
You may download and print any of our forms listed below prior to your visit. You may either bring them with you to your first visit or fax them before your appointment. If sending via fax, please verify with us that we received your forms prior to your visit.
Our fax number is (972) 475-5708.
Some parents have asked if the completed forms can be sent to us via email. You may do this, but please be aware that email is not a secure medium. The information can conceivably be intercepted and read by someone other than Lake Pointe Pediatric Associates. If you would still like to use email, you can send completed forms to
Please verify with us that we have received your email prior to your visit.
We use encrypted email if we send any protected information to you. The emails we send are automatically deleted 2 weeks after they are sent. Be sure to open them and print or save any information you wish to keep before the 2 week period expires.
Patient Care Forms
Dr. Wieland ADHD New Patient Packet
Dr. London ADHD New Patient Packet
Headache and Stomach Ache Questionnaire
Influenza Vaccination Questions
Tuberculosis and Lead Exposure Risk Questionnaire
Well Child Questionnaires
Administrative Forms:
New Patient Forms:
Authorization to Obtain Records From Another Provider
Patient Information Disclosure Instructions
Authorization for Treatment of Minors
Payment Terms for Services Rendered
Other Administrative Forms: