The Pediatric Surgical Associates team includes our board certified pediatric surgeons, medical staff and administrative professionals dedicated to your child’s health, comfort and well-being. We are also committed to providing you with excellent care and friendly, professional service.
For your convenience, you may print forms to complete and bring with you to your child’s FIRST office visit. This will save you considerable time. Be sure to bring all pages with you.
Click on the form below, then click the small icon that looks like a printer toward the top left of the next screen.
New Patient Information Form
New Patient Information Form (Espanol)
HIPAA Consent Form
HIPAA Consent Form (Espanol)
Medical History Form
Medical History Form (Espanol)
Pediatric Surgical Associates contracts with most insurance companies. We accept and file many insurance plans. If you do not see your insurance carrier listed below, call our office to verify coverage.
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Aetna |
Health Network |
USC Health Services |
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Admar |
HealthSmart Preferred Care |
North Texas Healthcare |
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Affiliated |
Humana Choice Care |
One Health |
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Amerigroup |
Medicaid |
PPO Next |
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Accountable |
Multiplan |
PPO Next |
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Blue Cross (BC/BS) |
CIDC |
Private Health Care Systems |
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Beech Street/Capp Care |
Emergis |
Poly America |
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Benefit Planners |
BCE |
Provider Networks of America |
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Cigna |
ProAmerica |
Superior Health Plan (CHIP) |
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Community Care Network/CCN |
Formost |
Texas True Choice |
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Cook Children's Health Plan |
UP&UP |
Tricare |
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First Health |
WellMark |
Unicare |
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FirstCare |
Preferred Plan |
United HealthCare (UHC) |
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Galaxy |
National HealthCare Alliance (NHA) |
USA Managed Care |
We also gladly accept Visa, Mastercard, Discover and American Express. Have a question about insurance or payment?
Call us now at (817) 336-7881 or E-mail our team now. |
