General Clinic Forms 

*New to Clinic Patient Forms

1. New Patient Information Form

2. Medical Record Release Form

3. New Patient Health Questionnaire

4. HIPAA - Patients less than 18 years

5. HIPAA - Patients over 18 years

6. HIPAA Guidelines - Patients over 18 years

7. Consent for Treatment form without Parent or Legal Guardian

Flu Vaccine Screener - This screener is for ALL parents and ANYONE receiving flumist.

Teen Health Questionnaire & Sport Physical Form:

     These forms are intended for middle school & high school or older patients.

* Please print form & complete page 1 prior to your office visit

                                                            bring both pages to your visit:

             1. Middle school Sport Physical Form - Page 3 & 4

             2. High School Sport Physical Form - Page 1 & 2

Teen Questionnaires - for patients 13 years and older

            CRAFFT Questionnaire

Transition Questionnaire - for 16 years and older

PHQ-9 Depression Questionnaire - for patients 13 - 17

Beck's Depression Questionnaire - for patients 18 years and older

3040 - School Entry-Day Care health form<-- Click for form

* Please print form & complete page 1 prior to your office visit.

Bring both pages to your visit.

ADD - ADHD (Vanderbilt) Questionnaires

       1. Initial Assessment - Parent

       2. Initial Assessment - Teacher

       3. Follow-up Assessment - Parent

       4. Follow-up Assessment - Teacher

Controlled Substance Contract

Developmental Screens  

American Academy of Pediatrics -

Well Child Visit Teaching Sheets

Bright Futures