New Patient Forms
In order to help our staff serve you better, we ask that you download, print and complete the list below prior to your appointment.
- Financial Policy – Please print, sign and keep a copy for your records. An updated signature page is required annually.
- Office Policies – Our office, phone, email, mail policy. – Please print, sign and keep a copy for your records. An updated signature page is required annually.
- Patient Demographic Patient Information Sheet – Each year we need you to fill out a new sheet to keep in your chart.
- Consent to Treat Minors
- Heritage Pediatrics Privacy Practices – Please read and keep for a copy for your records.
- Medical Records Release Form – New Patients
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. Please download and complete the following before your child’s appointment.
- Parent ADHD Evaluation Form
- Flow Sheet for Parents when Evaluating Your Child for ADHD
- Teacher ADHD Evaluation – Teacher Evaluation Form
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.
Here are the follow-up Vanderbilt questionnaires for download:
