Patient Information

In an effort to make each appointment go as smoothly as possible, we ask that you complete relevant patient forms prior to your child’s visit. Feel free to complete the patient forms online or print and bring them with you to the appointment. 

• Patient Form (Digital)
• Patient Form (Print)
• Consent for Treatment in Absence of Legal Guardian (Print)

If you have any questions about the information on these forms or about your appointment in general, please feel free to contact us online or call 512-456-9423.

Si no deseas enviar las Formas para Pacientes en linea, por favor descarga las siguientes formas, completalas y traelas a la oficina para tu cita.

• Formas del Paciente
• Consentimiento de Guardián Legal
• Consentimiento para el Tratamiento en la Ausencia de Guardian Legal

Our mission is to provide the highest quality of healthcare to your child. Increasing communication and the involvement of parents as a part of the team makes the job of supporting children and families easier during times of a stressful healthcare experience.

Prior to your child’s surgery, please fill out any required patient forms. Additionally, we recommend taking a few simple steps to prepare your child for their stay with us:

• Ask your physician and staff at the hospital questions so that you and your child will know what to expect.
• Be Honest! Telling your child the truth about what will happen and how things will feel will let them know what to expect. Be sure to use simple explanations suitable for your child’s development.
• Listen to your child’s questions and talk about them. If you don’t know the answer, write the question down to ask out staff later.
• Allow your child to explore with real or pretend medical equipment on stuffed animals or dolls before going to the hospital and when he/she comes home. This helps your child to express their feelings and feel more in control.
• Read Curious George Goes to the Hospital or other stories about children’s health care experiences.
• Let your child pack special things to take to the hospital. He/she can pack pictures of your family, books, videos, toys, comfort items (stuffed animal, blanket, or pillow), schoolwork, or even favorite pajamas or clothes to wear home.

If your child’s surgery is scheduled at Dell Children’s Medical Center please read how to prepare your child for surgery at Dell Children’s. Take the opportunity to view the pre-operative virtual tour to learn more about your child’s pending surgical experience. The link also provides information regarding instructions for the day before surgery, anesthesia and driving instructions to Dell Children’s Medical Center. 

If your child is having surgery at the Strictly Pediatrics Surgery Center, you can find more information about what to expect while they are a patient at the Surgery Center.

The Pre-operative Tour is a hands-on teaching program for children and their families who are scheduled for surgery or for a procedure with sedation at Dell Children’s Medical Center.

All families are encouraged to attend this program, which helps promote an understanding of surgery and medical procedures. Research has shown that preparing children can reduce stress and increase their ability to cope.

A Child Life Specialist will introduce the medical equipment children may see on the day of their surgery or procedure using age-appropriate language, sensory information, and will explain the sequence of events for surgery. The Child Life Specialist will then lead a tour of the waiting room, check-in area, operating room, and recovery room. (Touring these areas depends on the availability of these rooms.) 

Brothers and sisters are welcome to attend because a hospital visit can affect the whole family.

For tour dates and times and to make a reservation, please call the Surgery Child Life Specialist at 512-324-0146.

1. Keep the dressing clean and dry. If there is not a dressing, remember to keep the surgical site clean and dry as well. After surgery, between days five and seven, you may remove the outer dressing. Do not remove the small pieces of tape (steri-strips) under the outer dressing. These will fall off within 1-2 weeks.
2. Some irritation, mild bruising, or swelling is normal for the first seven days after the surgical procedure. If the redness gets worse instead of better, please call the office.We recommend that your child try some clear fluids until it appears that he/she is not nauseated. You may gradually advance your child’s diet, but take care not to force him/her to eat or drink.
3. Your child may shower or be given a sponge bath unless instructed by your surgeon. No swimming or tub baths are allowed until the seventh to tenth day after surgery.
4. Please make sure that you understand the pain control measures provided for your child prior to discharge; it will make recovery at home easier. Do not give Tylenol and Tylenol with codeine at the same time, as that would result in a dangerous overdose of Tylenol.
5. Activity is allowed as indicated by your surgeon and varies depending on the procedure.
6. If your child develops constipation, we recommend that you discontinue codeine if possible and provide substances that often encourage a bowel movement (pear nectar, prune juice, grape juice, increase fluids). If these are unsuccessful an over the counter laxative or suppository may be useful.
7. Call your doctor if:
   1. Temperature is 101.5 or higher
   2. Excessive bleeding, drainage, or spreading redness
   3. Unrelieved constipation after 2 days
   4. Persistent nausea or vomiting
8. If you have questions or concerns regarding your child, please do not hesitate to call us at (512) 708-1234.

For additional information regarding our professional associations, resources, and partners, please see the links provided below.

• American Pediatric Surgical Association
• American Pediatric Surgical Association Parent Resources
• American Academy of Pediatrics
• What is a Pediatric Surgeon
• Dell Children’s Medical Center
• Strictly Pediatrics Surgery Center

Austin Pediatric Surgery strives to offer the highest level of comprehensive care.  One way our team accomplishes this is through arranging necessary payments prior to surgery, maximizing efficiency and minimizing stress on the scheduled date. In order to best accommodate our patients, we honor a variety of common payment options and clearly detail any necessary information that needs to be provided to our office ahead of time.

The first method of accepted payment is through your current heath insurance coverage.  If you have coverage, you will be asked to provide insurance information such as the name, address and phone number of your insurance company, current subscriber name, certificate and/or policy number and effective date of your plan.  It is very important that you provide accurate information so that insurance coverage can be verified prior to your child’s surgery.  Most of this information can be found on your insurance I.D. card.  Please remember to bring your card with you when you come to our office, as well as a photo ID.

It is Austin Pediatric Surgery’s policy to collect any estimated private-pay balances, co-pays, deductibles or coinsurance at the time of service. Our billing department will let you know how much you will be expected to pay before your child’s surgery. Please call our office if you have any questions. We accept cash, check or credit card.

If you do not have medical insurance, our billing department will assist you in establishing a payment plan. A deposit is due when the surgery is scheduled. If you are unable to make a deposit, you will need to make arrangements with our billing department prior to scheduling the surgery. They will advise you of available options, including available medical assistance programs.

If you belong to a managed care plan, you may need prior approval or pre-certification before your child’s surgery. In some cases, managed care plans will not pay unless pre-certification is complete. Please check with your managed care company to see what is required. Make sure you keep a record of the date, time and person you spoke with at your managed care company.

All patient health care information at Austin Pediatric Surgery is strictly confidential. Therefore, medical records cannot be released to any person or organization without the consent of the patient or the patient’s legally authorized representative (unless authorized by law).

To receive a copy of your child’s health information, an authorization to release medical information must be signed and dated by the parent or legal guardian. If you wish to obtain a copy, please complete the Medical Records Request (pdf) form and fax, mail, or bring to our office. Or you may provide the following information in a letter format.

Please provide:

• Patient name and address
• Patient date of birth
• Name of person to whom information is to be disclosed and relationship to patient
• Address of person to whom information is to be disclosed
• Specific health information to be disclosed
• Purpose for the release of information

A fee of $25.00 will be assessed to cover the cost of copying and sending your record. If the records are being faxed or mailed to another medical facility, there is no charge.

Completed authorization forms may be submitted to Austin Pediatric Surgery by mail, in person, or by fax.

Mailing address:
Austin Pediatric Surgery
1301 Barbara Jordan Blvd Suite 400
Austin, TX 78723

Fax number:
(512) 708-4567