How to become a patient at KidMed:
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.
*KidMed is currently only accepting first-time mothers with private health insurance.
New Patient Forms
- KidMed Financial Policy
- KidMed Authorization Form
- KidMed Pediatric History Form
- KidMed Demographic Form
- KidMed Patient Responsibility Agreement
- KidMed Minor Model Release Form
- KidMed Consent to Treat Form
Expectant Mothers Only:
Please contact our office at 409-363-5711 or stop by during clinic hours to get our pre-registration form.
This form must be filled out and approved before your little one arrives.