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Forms - Other Forms |
- ADHD Parent Packet - introduction to the process and the questionnaires with a Health History Form
- ADHD Parent Questionnaires - to be answered by each parent individually
- ADHD Connors and Vanderbilt Parent Questionnaires - to be answered by each parent individually
- ADHD Teacher Packet – given to the main teacher, principal, counselor, or other administrator who can provide the requested information
- ADHD Teacher Questionnaires - given to 1-3 teachers who have direct observation of and/or supervision over your child
- ADHD Connors and Vanderbilt Teacher Questionnaires - given to 1-3 teachers who have direct observation of and/or supervision over your child
- ADHD Teen Patient Checklist - questionnaire teenagers fill out for themselves
- ADHD Teen Patient Parental Observation Checklist - questionnaire for parents about their teenagers
- ADD Behavioral Rating Scale
- ADHD Medication Overview - information regarding ADHD medications
- Health History Questionnaire - general health questionnaire for all new patients
- Patient Contact Information Form - contact information for patients and their family
- Health Plan Eligibility Certification Form
- Consent for Treatment Form - consent to treat a minor and acknowledgement of policies at South East Bay Pediatrics
- Vaccine Designee Consent Form - allows another adult other than the child's parents(s) to sign for vaccinations
- Consent for Elective or Travel Vaccines
- Authorization to Release Medical Records TO South East Bay Pediatrics - allows us to obtain medical records, including growth curves and immunizations, from your previous pediatrician
- Authorization to Transfer / Copy/ Inspect Medical Records FROM South East Bay Pediatrics - request to transfer records to another physician outside of our practice, copy medical records for your files, or examine your child's chart