Patient Forms
For your convenience, the following forms are available to print and complete prior to an appointment in our office. Please give your completed forms to our staff member at the check-in desk upon arrival in the office.
New patient/newborn forms:
Change of address/phone number/ custody/ emergency contacts:
Medical Record Release and Consents:
- Release Medical Records TO Kids Creek
- Release medical records FROM Kids Creek
- Consent to Treat for Today's Visit
- Consent to Treat for 1 year
- Consent for treatment while parents away
- Notice of Privacy Practices
ADHD Vanderbilt Evaluation Forms:
ADHD Vanderbilt Follow-up Forms:
Sports Physical Forms:
School / Daycare Forms:
Boy Scouts Medical Forms:
Anxiety/Depression Forms:
- SCARED Screen for Child Anxiety Related Disorders: Parent version
- SCARED Screen for Child Anxiety Related Disorders: Child version
- PHQ-9 Patient Health Questionnaire