Skip to content
Instagram
ADHD Refill
Health Topics
New Patients
Pay Online
Careers
Well Visit Request
Search for:
Home
About
About Us
Doctors
Locations
All Locations
Cypress (Hwy 290 and
Huffmeister
)
Fairfield (Hwy 290 and
Mason
)
Greater Heights
Katy
Memorial
Sienna
Sugar Land
Woodlands
Blue Fish Timeline
Services
Well Child Check-up Request Form
2024-2025 Flu Season Information
ADHD Refill Request
Telemedicine Information
Medical Services
Referrals
Patient Portal
School and Health Forms
Before the Stork
After Hours
Resources
New Patients
Forms
Health Topics
Blue Fish Careers
News + Announcements
Online Bill Pay
FAQs
Helpful Links
Contact
Search for:
Home
About
About Us
Doctors
Locations
All Locations
Cypress (Hwy 290 and
Huffmeister
)
Fairfield (Hwy 290 and
Mason
)
Greater Heights
Katy
Memorial
Sienna
Sugar Land
Woodlands
Blue Fish Timeline
Services
Well Child Check-up Request Form
2024-2025 Flu Season Information
ADHD Refill Request
Telemedicine Information
Medical Services
Referrals
Patient Portal
School and Health Forms
Before the Stork
After Hours
Resources
New Patients
Forms
Health Topics
Blue Fish Careers
News + Announcements
Online Bill Pay
FAQs
Helpful Links
Contact
Lusk Transfer Form
Sam Oh
2024-05-15T15:08:27-05:00
Lusk Transfer Form
This form is for patients of Dr. Lusk to let us know which transfer option they choose.
Patient First Name
(Required)
Patient Last Name
(Required)
Patient Date of Birth
(Required)
Month
Day
Year
Please choose from the following options:
I would like to follow Dr. Lusk to the Blue Fish Fairfield location.
I would like to stay at Blue Fish Memorial.
I would like to transfer to another Blue Fish location.
I would like to transfer outside of Blue Fish Pediatrics.
Option chosen: I would like to follow Dr. Lusk to the Blue Fish Fairfield location.
A member of the Memorial front office will reach out to reschedule any future appointments scheduled after DATE.
For current patients who would like to schedule an appointment after DATE, please contact Blue Fish Fairfield at
832-334-4011
or
bluefishfairfield@bluefishmd.com
to request transfer of care.
Option chosen: I would like to stay at Blue Fish Memorial.
A member of the Memorial front office will reach out to reschedule any future appointments scheduled after DATE. At that time you can inform them that you would like to remain a patient at our Blue Fish Memorial location.
We have three physicians currently accepting patients at our Memorial location.
Dr. Tedja LINK
Dr. Zeng LINK
Dr. Reinhackel LINK
For current Blue Fish Memorial patients who would like to schedule an appointment after DATE, please contact Blue Fish Memorial at
713-467-1741
or
bluefishmemorial@bluefishmd.com
to switch to one of the physicians listed above.
Option chosen: I would like to transfer to another Blue Fish location.
Please contact the
location
of your preferred provider to request a transfer of care.
You will be welcomed into their practice if they are accepting new patients.
Option chosen: I would like to transfer outside of Blue Fish Pediatrics.
Please reach out to that office to join their practice and have them send us a release of medical records request or email us the
completed request form
from our website. There is no charge to transfer records to another pediatrician.