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)

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.