KidMed Pediatrics Beaumont-New Patients

 

How to become a patient at KidMed:

*KidMed currently only accept private insurance for new patients.

Step 1: Fill out a New Patient Registration Form and turn it in to the clinic. Our friendly staff can do it with you over the phone if you are having problems.

Step 2: If approved, contact your previous pediatric clinic to request that your medical records be sent to KidMed. The fastest way is for the previous clinic to directly fax them to us at: 409-363-5712. You will need to sign a release of information (ROI) form to release the records. If you cannot get one from your previous clinic, we have one for you here.

Step 3: Fill out the New Patient Forms below. Every patient at KidMed needs to fill these out even if they are a previous patient of Dr. Bell. You can turn these forms in before or at your child’s first appointment.  Expectant mothers only need to complete the KidMed Pre-registration Form.

Step 4: Call for an appointment. Call us during business hours at 409-363-5711 to schedule an appointment. Please note: appointments cannot be made outside of business hours.

New Patient Forms:

  1. KidMed Privacy Policy
  2. KidMed Financial Policy
  3. KidMed Authorization Form
  4. KidMed Pediatric History Form
  5. KidMed Demographic Form
  6. KidMed Patient Responsibility Agreement
  7. KidMed Minor Model Release Form
  8. KidMed Consent to Treat Form

Expectant Mothers Only:

  1. Pre-registration Form