New Client Registration

Welcome to Purely Pediatric Wellness!

Thank you for considering us as a partner in your child’s healthcare journey. We are honored to care for children and young adults from birth through 21 years of age.

Please complete this registration form for each child you would like to establish with our practice. Expecting parents are welcome to register before their baby arrives—simply enter your estimated due date in place of the birth date, and we will update the information once your little one is here.

After your registration form has been submitted, a member of our team will contact you to complete the remaining intake paperwork, answer any questions you may have, and securely collect a card on file for your account.

Phone/Text: (214) 250-3858
Email: hello@purelypediatricwellness.com

We look forward to welcoming your family to Purely Pediatric Wellness!