Preparing for a visit
For your convenience, we've provided patient information and consent forms here. Just print them out, fill in the information, sign them and bring the completed forms with you when you come in for your appointment.
New patients, please have your insurance information ready when you call.
Patient information and consent forms:
Note: Because our staff at Cook Children's Urgent Care in Southlake handles illnesses and injuries that vary in severity, patients that come to our facility are treated based on the urgency of their needs.
Fees, payments and insurance
- Fees, insurance co-payment and deductibles are due at each visit.
- Please bring insurance identification to every appointment.
- Let us know when there are changes in insurance coverage, address, employment or phone numbers.
- For more information on Cook Children's financial and billing information, click here.
Insurance plans accepted as of January 2, 2014:
- AmeriGroup CHIP/CHIP Perinate
- AmeriGroup STAR
- Cigna Healthcare of Texas
- LifeSource Transplant Network
- Cook Children's Health Plan/CHIP
- Cook Children's Health Plan/STAR
- First Health Network
- FirstCare STAR
- Galaxy Healthcare Network
- Health Payors Organization
- Interplan Health Group/Accountable
- Humana Choice Care/National POS
- Humana Concentric Network
- Humana Transplant Network
- Beech Street
- MultiPlan Inc/PHCS
- Oklahoma Healthcare Authority
- OptumHealth Behavioral Solutions
- OptumHealth Care Solutions
- Providence Health Alliance
- Scott & White Health Plan
- Superior Health Plan CHIP/CHIP Perinate
- Superior Health Plan/STAR Health
- Texas Medicaid
- United Healthcare
- USA Managed Care Organization
Not all of the above plans are accepted by all affiliated companies of Cook Children's Health Care System. Please verify with your insurance company regarding your individual plan.
*Blue Cross Blue Shield is not accepted for urgent care services at this time.
Request medical records
Cook Children's keeps a record of each lab, X-ray, medical center or specialty clinic visit. The privacy of this information is protected by federal and state regulations. This means your medical information is only available to the Cook Children's health care professionals caring for you or your child. Everyone else must get special permission (called authorization) before the information can be released.
Specialty care referrals
At Cook Children's, we provide more than 60 pediatric medical and specialty clinic offices to support your child if they require specialized care. We offer child-friendly medical and surgical technology, as well as care designed to help children and their families feel at ease and safe during a stressful time.
- Referrals to a specialist may be made by your doctor. However, no referrals are made until your child has been seen by his or her primary care physician.
- If you are a member of a managed care plan (HMO), a referral form is required for treatment by a specialist. Allow five to seven working days for the referral to be completed and mailed.
Cook Children's specialty clinics:
Cook Children's Home Health services:
Sometimes kids need long-term care, or will heal better in a familiar setting. We can assist in arranging referrals for quality, patient-centered care in the comfort of home through Cook Children's Home Health. Led by a clinical team with vast experience in pediatrics, our visiting nurses have a minimum of five years of pediatric experience and our skilled visiting nurses are PALS certified.
New patients, for your convenience, please have your insurance information ready when you call. 682-885-6000.