Patient Forms

As of 1/1/2025 Heritage Pediatrics has initiated a Credit Card on File system for all patient accounts.   Our policy for this can be reviewed here: Heritage Pediatrics CCOF Policy


New Patient Forms and Policies

In order to help our staff serve you better, we ask that you download, print and complete the list below prior to your appointment.

ADHD Evaluation

If you are seeking an ADHD evaluation, our physicians will need the following evaluation forms completed so that they may review them with you during your child’s appointment.  If you haven’t scheduled this visit, please call our office. We schedule more time for these visits and thus they are limited in how many we schedule each week. At some times of the year, we are booked out a couple of months for these visits.

The process of evaluation is outlined here: Flow Sheet for Parents: Evaluating Your Child for ADHD

Please download and complete the following before your child’s initial appointment.

If your child is already on medication for ADHD, here are the follow-up Vanderbilt questionnaires for download:

Heritage Pediatrics ADHD Prescription Management Policy is published here: ADHD Prescription Management Policy