Online Forms & Handouts

Which form do you need to fill out? This page will get you started!

  1. Locate the appropriate age for your child’s check-up.
  2. Click on the forms, completing them in sequence.
  3. After you submit one form, you will land again here where you can complete the next one.
  4. 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
New Patients CALL FIRST
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1 Month
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2 Months
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4 Months
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6 Months
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9 Months
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12 Months
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15 Months
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18 Months
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2 Years
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2 1/2 Years
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3 Years
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4-7 Years
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8-10 Years
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11-12 Years
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13-18 Years
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