Thank you for choosing Kids Creek Children's Clinic as your child's medical home, where we endeavor to provide a comfortable, caring environment so our patients and their families can feel at ease. To that end, we have included helpful items on this page to ensure that your child's first trip to our office is as pleasant, productive, and stress-free as possible

Our Mission

Our mission is help each child reach his or her optimal level of health and well being through building life-long relationships with our patients, consistently providing compassionate care of the highest quality and excellence, as well as cost effectiveness and value. To fulfill this mission, we are committed to:

• Treating each person with dignity, respect and compassion.
• Listening to our young patients and their families and valuing what they have to say.
• Achieving a path of optimal health and wellness in partnership with child and family.
• Continually pursuing excellence at all levels through continuing education.

If you are preparing for your child's first visit, you can do a few things to help make things go as smoothly as possible. Please be prepared to  provide the following information when you arrive for your visit:

• Insurance information
• Complete immunization records
• Medical records from your previous pediatrician (we can help you with this)

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:

• Family Information Form 
• Patient and Family History Form

Change of address/phone number/ custody/ emergency contacts:

• Family Information Form

Medical Record Release and Consents:

• Release Medical Records FROM Kids Creek
• Release medical records TO 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 Parent Forms:

• ADHD Vanderbilt Parent Initial Rating Form
• ADHD Vanderbilt Parent Follow-up Form

ADHD Vanderbilt Teacher Forms:

• ADHD Vanderbilt Teacher Initial Rating Form
• ADHD Vanderbilt Teacher follow-up form

Sports Physical Forms:

• Michigan High School Athletic Assoc.  Sports Physical Form

School / Daycare Forms:

• TCAPS Medication Authorization Form
• Health Appraisal Form

Boy Scouts Medical Forms:

• Boy Scouts of America Medical Form

Anxiety/Depression Forms:

• SCAERED Screen for Child Anxiety Related Disorders
• PHQ-9 Patient Health Questionaire

In order to view or print these forms you will need Adobe Acrobat Reader installed.
Click here to download it.