Welcome to Coppell Pediatrics. As a new patient, we will need some information from you. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
Our online form uses the latest Adobe Acrobat Reader plug-in to conveniently submit the form from home or work. Please download the free plug-in from Adobe's web site if it is not already installed on your system. It is important that you have at the latest version of the plug-in to successfully use our online form.
You must open and submit the form in a Safari Browser with the latest Mac operating system. It is also important to have the latest version of Adobe Acrobat Reader on your computer in order to submit your form to our office correctly, please download the free plug-in from Adobe's web site. You Must OPEN the Adobe Reader Application after installation and make Adobe Reader your DEFAULT SAFARI PLUGIN for Viewing PDF Files.
Coppell Pediatrics –
1705 E. Beltline Rd.
Coppell, TX 75019 – phone: 972-393-8687 – fax: 972-393-4975
Drs. Schlichtemeier and Raja are pediatricians in Coppell, TX serving the communities of Grapevine,
Flower Mound, Lewisville, Carrolton and surrounding areas.