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NORTH AUSTIN PEDIATRICS P. A. Leighton E. Ellis M. D. Erica C. Sharp M. D. Melissa Hinostroza PA-C Rebekah Sperling M. D. Christine Lam D. O. Kristen Pickering M. D. 12201 Renfert Way Ste. 110 Austin TX 78758 Phone 512 491-5125 Fax 512 491-8521 After Hours 512 660-5396 1401-B Medical Parkway Ste. B Suite 100 Unless otherwise revoked this authorization will expire six months from the date signed. I understand that authorizing the disclosure of this health information is voluntary. A. to obtain...
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Start by gathering all necessary personal and medical information.
02
Visit the official North Austin Pediatrics website.
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Locate the 'Forms' section and download the 'North Austin Pediatrics P' form.
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Open the downloaded form using a PDF reader.
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Carefully read and understand each section of the form.
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Fill in your personal information accurately, including your full name, address, contact details, and date of birth.
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Provide your medical history, including any existing conditions, medications you are currently taking, and allergies.
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If applicable, provide the name and contact information of your primary care physician.
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Save the filled-out form on your device for future reference.
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Print out a copy of the completed form.
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If required, sign the form using a pen or electronic signature.
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Submit the filled-out and signed form to North Austin Pediatrics via mail, email, or in person.
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Wait for confirmation from North Austin Pediatrics regarding the receipt and processing of your form.

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Parents or legal guardians of children who require pediatric medical care.
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North Austin Pediatrics P is a pediatric clinic located in North Austin.
North Austin Pediatrics P is required to file by the clinic's designated financial manager.
To fill out North Austin Pediatrics P, the financial manager must provide all relevant financial information for the clinic.
The purpose of North Austin Pediatrics P is to report the clinic's financial status and activity.
North Austin Pediatrics P must report income, expenses, assets, liabilities, and any other financial data relevant to the clinic.
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