make an appointment
(option 1)


New Patients Forms

Please complete the following forms AFTER you have scheduled your appointment:

Consent Form – English     /     Formulario de Consentimiento – Español

Intake Form – English     /    Formulario de Admisión – Español


Records Requests

  • PDF Records Request Form
    • submitted via email, fax, or mail
    • may be used for any type of records request
  • Online Records Request Form
    • submitted online
    • may only be used when records are to be sent to another provider
    • best completed on touch screen device (such as phone or tablet) as signature is captured electronically


For WIC Clinics

To refer a WIC client to the Lactation Foundation: WIC to LF Referral Form


If you need assistance, please call our office at 713-500-2800, option 1.