Policies and Letters
Our Office Policies and Letters are available below in PDF format:
TVP as Your Medical Home
Welcome to Our Practice
TVP Vaccine Policy Statement
Missed/Late Appointment Policy
Financial Policy
Prescription Refill Policy
Well Visit Screen and Price List
Patient Masking Policy
Accepted Insurances
Chlamydial Screening
Speech and Language Services:
Speech and Language Services Policy Statement
Speech and Language Services Financial Agreement
Patient Forms
The following PFD 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
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)
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
7 – 21 Years
7 – 8 Year Visits – Parent
9 – 10 Year Visits – Parent
11 – 14 Year Visits – Parent
15 – 17 Year Visits – Parent