Patient Information

817-453-7770
agsdix-null

Hours

Mansfield Pediatrics begins answering phones for appointments at 7:30 AM. Doors open at  8:00 AM with our first schedule appointments at 8:15 AM. Our providers’ schedules vary in their start and end time for the day, but our office building remains open until 5:00 pm.

After Hours

On weekdays between 5:00 PM and 7:30 AM, weekends, and holidays, call 817-453-7770 for instructions to reach the after-hours Children’s Health Nurse Advice Line. The doctor on call will be contacted by the nurse if required.

Please contact the Children’s Health Nurse Advice Line first, as we want to prevent unnecessary trips to Urgent Care or Emergency Departments. If you do need to be seen, we recommend the following providers:

Cook Children's - Mansfield, TX
Children's Health - Mansfield, TX

New Patients

Preparing for your child’s first visit? To ensure a successful appointment, please bring your insurance cards, complete immunization records, and medical records from your previous pediatrician (and/or phone and fax number for previous healthcare provider).

Before your visit, please download the new patient forms below. Print and complete the forms and bring them to your appointment.

New Patient Forms

agsdix-fas fa-file-download

Telemedicine Consent Form

agsdix-fas fa-file-download

New Baby Form

agsdix-fas fa-file-download

New Patient Form

agsdix-fas fa-file-download

ImmTrac2 Immunization Registry – Minor

agsdix-fas fa-file-download

ImmTrac2 Immunization Registry – Newborn

agsdix-fas fa-file-download

Patient Demographic Form

agsdix-fas fa-file-download

Non-Parental Consent

agsdix-fas fa-file-download

Office Financial Policy

agsdix-fas fa-file-download

Medical Records Release (them to us)

agsdix-fas fa-file-download

Medical Records Release (us to them)

agsdix-fas fa-file-download

General Consent for Treatment and HIPAA Acknowledgement

Please download, fill out this form and email to frontoffice@mansfieldtxpediatrics.com

Use the free Adobe Acrobat Reader to fill out and sign this form. Adobe Acrobat Reader: https://get.adobe.com/reader/

Third Party Forms

Insurance, disability, FMLA, etc., may require up to seven days to complete. Daycare, school, and sports clearance will take 24-48 hours to be completed. These forms require a completed well-child checkup within the past year.

Insurance

We accept most major insurances.  We do not accept Medicaid, Molina, Amerigroup, or Ambetter. Please call the office for more information!

Address:
1825 Cannon Dr
Mansfield, Texas 76063
Hours:
Monday 8:00 AM - 5:00 PM
Tuesday 8:00 AM - 5:00 PM
Wednesday 8:00 AM - 5:00 PM
Thursday 8:00 AM - 5:00 PM
Friday 8:00 AM - 5:00 PM
Saturday & Sunday - Please contact the Children’s Health Nurse for advice