|AR Texas Pediatrics | 281-484-7619|
|11914 Astoria Blvd, Suite 450, Houston, 77089 TX|
|1111 Highway 6S, Suite 120, Sugar Land, 77478 TX|
Call 281-484-7619 today for an Appointment!!
Read consent form ahead of time, of your appointment!
CONSENT MUST BE SENT ASAP OR APPOINTMENT WILL NOT BE DONE.
If you are unable to print, scan and email back the consent form fill out the form on this page.
Required Text (Copy&Paste). email this consent below to firstname.lastname@example.org
"I am parent of [ insert child’s name, insert child’s DOB], give consent to AR Texas pediatrics to do tele visit appointment. I have read and agree with the consent form."