Forms

In order to prepare for your next visit and streamline our check-in process, please review, and complete the following forms. Remember to bring them to your visit.

New Patient Forms

• Physician Office Authorization Treatment Form
• Reading Family Practice New Patient Form
• Involvement in Care Form
• Records Release Form
• Healthy Habits Survey
• Modified Checklist for Autism in Toddlers
• Vanderbilt Parent Initial Assessment
• Vanderbilt Parent Follow-Up Assessment
• Vanderbilt Teacher Initial Assessment
• Vanderbilt Teacher Follow-Up Assessment
• Vanderbilt ADHD Assessment Scale - all forms combined

Established Patient Forms

• Records Release Form
• Healthy Habits Survey
• Ohio – School Medication Permit

Sports Pre-Participation

• Ohio – OHSAA Pre-Participation Evaluation Form
• Indiana - IHSAA Pre-Participation Evaluation Form