New Patient Forms

• Patient Registration Form
• Credit Card Authorization Form
• HIPPA Release of Health Information Form
• Authorization/Consent to the Treatment of a Minor
• Missed Appointment Clause
• Notice of Privacy Practices
• Patient Record of Disclosure
• Record Release Request Form

Clinical Screening Forms

• Asthma Control Test (ages 4–11)
• Asthma Control Test (ages 12+)
• NICHQ Initial Evaluation Form
• NICHQ Assessment Scale-Parent Informant Form
• NICHQ Assessment Scale-Teacher Informant Form
• Sports Physical Clearance Form
• Sports Physical Patient History Form
• Sports Physical Special Needs Form

Over 18 Forms

• Over 18 Responsibility Agreement

Prenatal Consultation Forms

• AAP Prenatal Report
• AAP Recommended Screenings
• Expectant Parent Consultation
• Vaccine Schedule (ages 0–18yrs.)
• Vaccine Schedule Catchup

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