Question 1

New Patient Forms

Accepted Answer

<ul class="rteBlock defaultList"><li no_space_b="true" no_space_e="true"><a value="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/New-Patient-Registration-Form.pdf" label="" type="file" file="true" href="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/New-Patient-Registration-Form.pdf" data-runtime-url="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/New-Patient-Registration-Form.pdf" no_space_b="true" no_space_e="true">New Patient Registration</a></li><li no_space_b="true" no_space_e="true"><a value="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Canecellation+Policy.pdf" label="" type="file" file="true" href="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Canecellation+Policy.pdf" data-runtime-url="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Canecellation+Policy.pdf" no_space_b="true" no_space_e="true">Cancellation Policy</a></li><li no_space_b="true" no_space_e="true"><a value="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Office+Policy-Code+of+Conduct+%281%29.pdf" label="" type="file" file="true" href="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Office+Policy-Code+of+Conduct+%281%29.pdf" data-runtime-url="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Office+Policy-Code+of+Conduct+%281%29.pdf" no_space_b="true" no_space_e="true">Code of Conduct</a></li><li no_space_b="true" no_space_e="true"><a value="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Dr+K+Peds+Vaccine+Policy.pdf" label="" type="file" file="true" href="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Dr+K+Peds+Vaccine+Policy.pdf" data-runtime-url="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Dr+K+Peds+Vaccine+Policy.pdf" no_space_b="true" no_space_e="true">Vaccine Policy</a></li><li no_space_b="true" no_space_e="true"><a value="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/New+Patient-initial-history-questionnaire.pdf" label="" type="file" file="true" href="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/New+Patient-initial-history-questionnaire.pdf" data-runtime-url="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/New+Patient-initial-history-questionnaire.pdf" no_space_b="true" no_space_e="true">Clinical History</a></li><li no_space_b="true" no_space_e="true"><a value="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Patient+Registration+Forms-Authorization+for+Treatment+%281%29.pdf" label="" type="file" href="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Patient+Registration+Forms-Authorization+for+Treatment+%281%29.pdf" file="true" data-runtime-url="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Patient+Registration+Forms-Authorization+for+Treatment+%281%29.pdf" no_space_b="true" no_space_e="true">Authorization for Treatment</a></li><li no_space_b="true" no_space_e="true"><a value="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Dr+K+Peds+Financial+and+Office+Policy.pdf" label="" type="file" file="true" href="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Dr+K+Peds+Financial+and+Office+Policy.pdf" data-runtime-url="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Dr+K+Peds+Financial+and+Office+Policy.pdf" no_space_b="true" no_space_e="true">Office Financial Policy</a></li><li no_space_b="true" no_space_e="true"><a value="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Dr+K+Peds+Patient+Consent+to+use+and+disclosure+of+Protected+Health+Information.pdf" label="" type="file" file="true" href="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Dr+K+Peds+Patient+Consent+to+use+and+disclosure+of+Protected+Health+Information.pdf" data-runtime-url="https://irp.cdn-website.com/7fb0a3f6/files/uploaded/Dr+K+Peds+Patient+Consent+to+use+and+disclosure+of+Protected+Health+Information.pdf" no_space_b="true" no_space_e="true">HIPAA Acknowledgement</a></li></ul>

Question 2

Additional Forms

Accepted Answer

Sports Physical Authorization Forms
Sports Physical Forms
Vanderbilt Assessment Initial Evaluation
Vanderbilt Assessment Post Evaluation
FMLA Questionnaire
Self-Pay Form

Question 3

Transition of Care Forms

Accepted Answer

Medical Record Release Form

Question 4

Telehealth Form

Accepted Answer

Telehealth Consent

Question 5

Behavioral Health Forms

Accepted Answer

ADHD Parent Follow-Up Form
ADHD Parent Initial Form
ADHD Teacher Follow-Up Form
ADHD Teacher Initial Form

Question 6

Sports/School Forms

Accepted Answer

Sports Physical Authorization Form
Sports Participation Evaluation Form

Question 7

Well Check Forms

Accepted Answer

<ul class="rteBlock defaultList"><li no_space_b="true" no_space_e="true"><a value="https://irp.cdn-website.com/94478288/files/uploaded/m-chat.pdf" label="" type="file" file="true" href="https://irp.cdn-website.com/94478288/files/uploaded/m-chat.pdf" data-runtime-url="https://irp.cdn-website.com/94478288/files/uploaded/m-chat.pdf" no_space_b="true" no_space_e="true">MCHAT</a></li><li no_space_b="true" no_space_e="true"><a value="https://irp.cdn-website.com/94478288/files/uploaded/SCARED-Anxiety-Screen-%28parent-to-fill-out%29.pdf" label="" type="file" file="true" href="https://irp.cdn-website.com/94478288/files/uploaded/SCARED-Anxiety-Screen-%28parent-to-fill-out%29.pdf" data-runtime-url="https://irp.cdn-website.com/94478288/files/uploaded/SCARED-Anxiety-Screen-%28parent-to-fill-out%29.pdf" no_space_b="true" no_space_e="true">SCARED Anxiety Screen (parents to complete)</a></li><li no_space_b="true" no_space_e="true"><a value="https://irp.cdn-website.com/94478288/files/uploaded/Edinburgh-Postnatal-Depression-Scale.pdf" label="" type="file" file="true" href="https://irp.cdn-website.com/94478288/files/uploaded/Edinburgh-Postnatal-Depression-Scale.pdf" data-runtime-url="https://irp.cdn-website.com/94478288/files/uploaded/Edinburgh-Postnatal-Depression-Scale.pdf" no_space_b="true" no_space_e="true">Edinburgh Postnatal Depression Scale</a></li><li no_space_b="true" no_space_e="true"><a value="https://irp.cdn-website.com/94478288/files/uploaded/GAD-7.pdf" label="" type="file" file="true" href="https://irp.cdn-website.com/94478288/files/uploaded/GAD-7.pdf" data-runtime-url="https://irp.cdn-website.com/94478288/files/uploaded/GAD-7.pdf" no_space_b="true" no_space_e="true">GAD-7</a></li><li no_space_b="true" no_space_e="true"><a value="https://irp.cdn-website.com/94478288/files/uploaded/SCARED-Anxiety-Screen-%28child-to-fill-out%29.pdf" label="" type="file" href="https://irp.cdn-website.com/94478288/files/uploaded/SCARED-Anxiety-Screen-%28child-to-fill-out%29.pdf" file="true" data-runtime-url="https://irp.cdn-website.com/94478288/files/uploaded/SCARED-Anxiety-Screen-%28child-to-fill-out%29.pdf" no_space_b="true" no_space_e="true">SCARED Anxiety Screen (child to complete)</a></li><li no_space_b="true" no_space_e="true"><a value="https://irp.cdn-website.com/94478288/files/uploaded/PSC-17.pdf" label="" type="file" href="https://irp.cdn-website.com/94478288/files/uploaded/PSC-17.pdf" file="true" data-runtime-url="https://irp.cdn-website.com/94478288/files/uploaded/PSC-17.pdf" no_space_b="true" no_space_e="true">PSC-17</a></li><li no_space_b="true" no_space_e="true"><a value="https://irp.cdn-website.com/94478288/files/uploaded/PHQ-9-Modified-for-Teens.pdf" label="" type="file" href="https://irp.cdn-website.com/94478288/files/uploaded/PHQ-9-Modified-for-Teens.pdf" file="true" data-runtime-url="https://irp.cdn-website.com/94478288/files/uploaded/PHQ-9-Modified-for-Teens.pdf" no_space_b="true" no_space_e="true">PHQ-9 (Modified for Teens)</a></li><li no_space_b="true" no_space_e="true"><a value="https://irp.cdn-website.com/94478288/files/uploaded/PHQ9-Adult.pdf" label="" type="file" href="https://irp.cdn-website.com/94478288/files/uploaded/PHQ9-Adult.pdf" file="true" data-runtime-url="https://irp.cdn-website.com/94478288/files/uploaded/PHQ9-Adult.pdf" no_space_b="true" no_space_e="true">PHQ-9 (Adult)</a></li></ul>

813-655-7726

813-655-7726

Forms

Office Forms & Policies