Administrative Forms
New Patient Information Online (PDF)
Baby Pre-Registration Online (PDF)
Patient Privacy and Consent to Treat (PDF only)
Non-parent authorization (PDF only)
Authorization for 16Y old and older (PDF only)
Foster Placement Information (PDF)
Transfer Records Authorization (PDF)
Authorization for Parents (18Y+ patients) (PDF only)

Behavioral Forms
First appointment:
Vanderbilt Parents (initial – PDF only)
Vanderbilt Teachers (initial – PDF only) (at least two teachers for school-aged children)

ADHD follow-up:
Vanderbilt Parents (follow-up – PDF only)
Vanderbilt Teachers (follow-up – PDF only)

Anxiety: SCARED form (PDF only – both needed:  SCARED form CHILD  and SCARED form PARENT)

Depression: PHQ-9 modified for Adolescents (PHQ-A)

Daycare, School & Sports
Immunization records: pick-up copy during business hours or request it to be mailed to address on file.
School health assessments: if your child is current on wellness checks, you may request a copy. You can choose to pick it up or have it mailed to the address on file.
Sports Physicals: fill out the packet from the school. Then we will fill out according to the exam.
Per KSHSAA regulations, the check-up should be done after May 1st. Call us for more information.