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Serving your child's unique skin care needs.
409-753-5720

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Patient FormsMeena Julapalli, M.D.2025-02-07T10:59:53-06:00

New Patient Forms

New Patient Registration Form
Notice of Privacy Practices
Acknowledgment of Receipt of Notices of Privacy Practices
Authorization Form for Payment and Medical Treatment
Parental Pre-Authorization for Medical Care to Minors
Authorization to Leave Personal Health Info by Alternate Means
Office Policies
Telemedicine Informed Consent Form

 

Referral Forms

Phototherapy Referral Form
Camp Discovery Referral

409-753-5720


2950 FM 2920, Suite 180 Spring, TX 77388
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 All Rights Reserved  | Disclaimer/Privacy Policy | Terms and Conditions
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Beginning 1/1/2026, there will be a slight increase in our New Patient Consultation and Follow-Up Visit pricing due to rising overhead costs. We’re excited to continue growing Bluebird Dermatology and offering and providing you and your child with the best possible experience. We understand that any price change requires adjustment. Current pricing will remain in effect until December 31st. Thank you for your continued support!

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