Pediatrics

For additional new patient forms click here

 

Pediatric History

For patients under the age 18.

 

Authorization and Consent for Non-Parent to Treat Minor

Please complete this form to allow non-parent to bring your child in for care.

 

UIL Sports Physical Form

Recommended Vaccinations for Infants and Children birth through 6 years

Recommended Vaccinations for Children 7-18 Years Old

Milestone Checklist

Use this to monitor your child's development

Download the Milestone Tracker App

Ages & Stages Questionnaires (ASQ)

Prior to your child's well child exam through 60 months of age, please complete the age appropriate Ages & Stages Questionnaire (ASQ-3).  This is a developmental assessment.  Any scoring will be done during the visit.

Please note that patients in the 18 months and 24 months age groups will also need to complete the M-CHAT questionnaire.  This is a screening tool for autism.

Kindly keep in mind that the age of premature babies up to 24 months counts differently. To avoid confusion, and for your convenience, please use this quick ASQ Age Calculator to ensure correct ASQ-3 questionnaire is chosen for your child’s age.

 

Child's Age                                                                                      English                                     Spanish

1 month 0 days through 2 month 30 days                                     2 month                                   2 month

3 months 0 days through 4 months 30 days                                  4 month                                   4 month

5 months 0 days through 6 months 30 days                                  6 month                                   6 month

7 months 0 days through 8 months 30 days                                  8 month                                   8 month

9 months 0 days through 9 months 30 days                                  9 month                                   month

10 months 0 days through 10 months 30 days                            10 month                                  10 month

11 months 0 days through 12 months 30 days                            12 month                                  12 month

13 months 0 days through 14 months 30 days                            14 month                                  14 month

15 months 0 days through 16 months 30 days                            16 month                                  16 month

17 months 0 days through 18 months 30 days                            18 month + M-CHAT               18 month + M-CHAT

19 months 0 days through 20 months 30 days                            20 month                                   20 month

21 months 0 days through 22 months 30 days                            22 month                                   22 month

23 months 0 days through 25 months 15 days                            24 month + M-CHAT                24 month + M-CHAT

25 months 16 days through 28 months 15 days                          27 month                                   27 month

28 months 16 days through 31 months 15 days                          30 month                                   30 month

31 months 16 days through 34 months 15 days                          33 month                                   33 month

34 months 16 days through 38 months 30 days                          36 month                                   36 month

39 months 0 days through 44 months 30 days                            42 month                                   42 month

45 months 0 days through 50 months 30 days                            48 month                                   48 month

51 months 0 days through 56 months 30 days                            54 month                                   54 month

57 months 0 days through 66 months 0 days                              60 month                                   60 month

23144 Westheimer Pkwy, Katy, TX 77494

Tel: 281.392.5005

Fax: 281.392.5052

Monday-Friday: 7:30 AM - 5:30 PM

Closed for lunch: 12:00 PM - 1:00 PM

Saturday and Sunday: Closed

Hours

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