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: fill out the initial packet.
For additional pages:
Vanderbilt Parents (initial – PDF only)
Vanderbilt Teachers (initial – PDF only)
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: CES-DC Bright Futures form (PDF)

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.