Forms & Documents
We’ve put together a collection of trusted resources and important documents to support your child's care.
Some visits require the completion of screening forms. These forms can be printed and completed prior to the visit. We are also implementing sending developmental screening tests and mental health screenings electronically to complete prior to visits. If you receive a message to complete a form, please do so within 24 hours.
General Forms
New patient packet– please bring completed forms to the first visit
Change of address form
2018 Asthma Form – should be filled out at yearly for all asthma patients
HIPAA Policy
Medical Records Release Form
Sports and School Forms
If it has been less than 12 months since your child's last well check, we can complete the form based on their previous visit without additional appointments. If your child's last well check has been over 12 months, they will need to be seen for a well check to complete school forms.
To ensure the accuracy of the forms we complete, we request the Athlete Information and the History Form (for completion assisted or unassisted by student and parents) portions of the forms be completed prior to submission. Also, please be sure to sign all required fields on the forms. The standard turnaround time is 3 to 4 business days.
Kentucky sports form grades 6-8
Kentucky sports form grades 9-12
Ohio sports form
ADHD Forms
The Vanderbilt Parent and Teacher Assessment Forms must be filled out and mailed to our office prior to an appointment to discuss if you child may have ADHD. The Vanderbilt Parent and Teacher Followup forms must be filled out and mailed to our office for any patient diagnosed with ADHD prior to a well check or an ADHD check.The followup forms should be filled out at least yearly for any patient who has been diagnosed with ADHD.
Vanderbilt Teacher Initial Assesment Form
Vanderbilt Parent Initial Assessment Form
Vanderbilt Teacher Followup Form
Vanderbilt Parent Followup Form
School Medication Forms
Most schools require medication forms if your child has been prescribed medications by our providers. These forms can be obtained from your child's school. Medication forms can be dropped off at our office for completion. Please complete the parent and child portions of the forms. The turnaround time is 3 to 4 days.
Pre-op Forms
If your child is scheduled for surgery, they will require a pre-op physical within 30 days of the surgery. Please schedule a "pre-op physical appointment" with our office and bring any pre-op physical forms from the surgeon's office.