If the adult accompanying your child to our office is not already listed on his/her Authorization for Medical Care form, please put the child’s name, accompanying person’s name, and your (parent’s/guardian’s) name in writing.  Please fax or email the authorization to our office or send it with your child at the time of the appointment.

9006 S Fry Rd, Ste D, Katy, TX 77494 | Tel: 281-665-3013 | Fax: 832-913-8163 | info@CincoWestPediatrics.com