Welcome to Pediatric Associates of Austin!
We’re so glad you’re considering Pediatric Associates of Austin for your family. Tell us a little about your family, insurance, and preferences below. Our team will review your information and help make getting started as easy as possible.
Tell Us About Your Family
What brings your family to Pediatric Associates of Austin?
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We’re expecting a baby
We’re adopting
We’re looking for a new pediatrician for our child/children
We’re a former Pediatric Associates family returning to the practice
Other
If expecting, when is your due date?
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
If adopting, what is your anticipated placement date?
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please enter your name.
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What is the best phone number to contact you?
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Please enter a valid phone number.
Format: (000) 000-0000.
What is the best email to reach you?
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example@example.com We’ll send a confirmation email after you submit this form. Please add us to your contacts so our message doesn’t end up in your spam or junk folder.
How many children are currently in your family?
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Please Select
0
1
2
3
4
5 or more
Is there a Pediatric Associates provider you’d especially like to see?
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Please Select
Christine Kasbarian, MD
Forrest Gangi, MD
Katie Sanford, MD
Lance Hargrave, MD
Lauren Karnesky, PNP
Margot Martino, MD
Samuel Mirrop, MD
No Preference - Help me Choose
No preference? That's completely fine — we're happy to help you find a provider who's a good fit for your family
Insurance Information
What is your primary insurance company
*
Let us know if you are planning to use insurance or if you will you be self-pay.
Insurance Card - Front and Back
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Referral Source
How did you first hear about Pediatric Associates of Austin?
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Friend or family
My OB/GYN
Another doctor or healthcare provider
Hospital or birth center
Google or another online search
Social media
Insurance directory
I was a patient at Pediatric Associates as a child
Another one of my children is already a patient
Other
Who referred you?
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