Download Office Forms

Unfortunately, paperwork is a necessary part of going to the doctor, and having insurance claims filed on your behalf. In order to speed up the time that you spend in the office, the following forms are provided here for you to download, complete, and bring with you to the office.

Some of these forms are part of our registration (and yearly re-registration) process. Others may deal with medical records or with particular evaluations that your pediatrician may use. See the individual descriptions for more information.

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Patient Information Sheet - 2010
This form is the Patient Information Sheet for 2010. We request that all of our patients complete a new copy of this form annually so that we have your most up-to-date information, and can file insurance claims on your behalf.

Medical Record Request
As a new patient, you may need to transfer records from your former pediatrician's office to Laurelwood. You may download this form to give permission for us to request records on your behalf.

Initial Health Questionnaire
If your child is a new patient to Laurelwood, please download and print this form to supply us with important health history.

Developmental Screen 18 Months
If you are coming to the office for an 18 month checkup, please complete this form and bring it with you to that visit.

Developmental Screen Age 5-10
If you are coming to the office for a checkup between ages 5 and 10, please complete this form and bring it with you to that visit.

Developmental Screen Age 11-18
If you are coming to the office for a checkup between ages 11 and 18, please have your child complete this form and bring it with you to that visit.

ADHD Evaluation Form - Parent
The Vanderbilt Parent Assessment form used in evaluating children who may have ADD or ADHD. Please print and complete this form prior to appointments for evaluation of learning or ADD / ADHD concerns.

ADHD Evaluation Form - Teacher
The Vanderbilt Teacher Assessment form used in evaluating children who may have ADD or ADHD. Please print and have your child's teacher complete this form prior to appointments for evaluation of learning or ADD / ADHD concerns.

American Academy of Pediatrics
The official site of the American Academy of Pediatrics

Le Bonheur Children's Medical Center
Memphis' own children's hospital

Cincinnatti Children's Hospital
Disease specific information from a well-known Children's hospital

Mayo Clinic
The well-known Mayo Clinic's repository of child health information

CHADD
Good resource for children and adults with ADD/ADHD

FDA Kids
Good site for kids to learn about health, nutrition, and immunizations

MEDLINE
Excellent information about various health conditions and diseases

Merck Manual Online Home Edition
The Merck Manual is a standard when it comes to disease information

SafeKids
A good resource for learning about child safety on the internet