Forms & Polices

New Patient Forms

• New Patient Registration
• Financial Agreement, Acknowledgement of Privacy Practices (Please read Notice of Privacy Practices)
• Health History
• Notice of Privacy Practice

Medical Consent Forms

• Request for Records
• Consent for Treatment of a Minor

ADD/ADHD & Other Evaluations

• Vanderbilt Parent Initial Assessment
• Vanderbilt Teacher Initial Assessment
• Vanderbilt Parent Follow Up
• Vanderbilt Teacher Follow Up
• M-CHAT (a screening tool designed to help doctors identify children aged 18 - 36 months who may be at risk for developmental delays)

School District Forms

• Authorization to Self-Carry Medication
• Long Term Request for Administration of Prescribed Medication
• Student Allergy Care Plan
• Student Asthma Action Card
• Kindergarten Physical
• Sports Physical