Online Forms & Handouts
Which form do you need to fill out? This page will get you started!
- Locate the appropriate age for your child’s check-up.
- Click on the forms, completing them in sequence.
- After you submit one form, you will land again here where you can complete the next one.
- The special forms for ADD/ADHD, TB, and Lead questionnaires need only be completed if staff instructs you to do so.
Forms Needed for Specific Checkups
New Patient Consent
Medical Records Request
Interim Medical History
HIPAA Consent
M-Chat
Children's Healthy Habits
Cholesterol Screen
Participation Physical History
Adolescents Healthy Habits
CRAFFT
PHQ-9