Handouts and Surveys

Patient Forms

The following PDF forms may be useful to you prior to your visits with us.

AIA Preparticipation Physical Evaluation (Sports Physical)

M-CHAT Developmental Questionnaire (for 18 mo and 24 mo visit)

Patient Consent for Use and Disclosure of Health Information

Authorization for Release of Medical Records

Language Development

First Words Tracker PDF

Development Handouts

For Infants, Children, Adolescents and Young Adults
Our development handouts are available in PDF format below. Please feel free to print them out if you have questions about age-related development. They are also viewable online. These handouts are available on your portal account prior to each appointment.

Parent Handouts

3-5 Day Visit
1 Month Visit
2 Month Visit
4 Month Visit
6 Month Visit
9 Month Visit
12 Month Visit
15 Month Visit
18 Month Visit
2 Year Visit
2-1/2 Year Visit
3 Year Visit
4 Year Visit
5 – 6 Year Visits
7 – 8 Year Visits – Parent
9 – 10 Year Visits – Parent
11 – 14 Year Visits – Parent
15 – 17 Year Visits – Parent

Patient Handouts

7 – 8 Year Visits – Patient
9 – 10 Year Visits – Patient
11 – 14 Year Visits – Patient
15 – 17 Year Visits – Patient
18 – 21 Year Visits – Patient

Surveys and Questionnaires

Please download, print and complete the specific survey recommended at your child’s appointment. Once complete, please portal message them back, or drop them off to clinic, then set up a follow up appointment to go through them with your child’s primary care pediatrician.

Vanderbilt Scale:
English
Spanish (Teacher Form)
Spanish (Parent Form)

SCARED Questionnaire:
English
Spanish (Child Form)
Spanish (Parent Form)

ADHD Preschool Rating Scale
GLAD-PC Survey
SCOFF Questionnaire
Trauma Scale