Unfortunately, paperwork is needed to go to the doctor and have insurance claims filed for you. To speed up your time in the office, We have included the following forms for you to download, complete, and bring to the office.

Some forms are part of our registration (and yearly re-registration) process. Others may deal with medical records or detailed evaluations that your pediatrician may use. Please take a look at the individual descriptions for more information.

Medical Record Release Authorization

Sometimes sending a copy of the medical record is necessary. You may complete this form and return it to our office to have documents sent to us from another physician’s office or to obtain a copy of your child’s records at Laurelwood.

Initial Health Questionnaire

If your child is a new patient to Laurelwood, please download and print this form to supply us with the necessary health history details.

2024 Patient Information

Before your first visit, please download and print this form so that we will have information about how to contact you and submit insurance claims for you.

Developmental Screen 18 Months

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

Developmental Screen Age 5-18

If you are coming to the office for a checkup between ages 5 and 18, please fill out this form and bring it to that visit.

ADHD Evaluation Form – Parent

The Vanderbilt Parent Assessment form is used to evaluate children with ADD or ADHD. Please print and complete this form before appointments to assess learning or ADD / ADHD concerns.

ADHD Evaluation Form – Teacher

The Vanderbilt Teacher Assessment form is used to evaluate children with ADD or ADHD. Please print and have your child’s teacher complete this form before appointments to assess learning or ADD / ADHD concerns.

Adult Self-Report Scale for ADHD

The ASRS tool is used in evaluating our older patients for symptoms of ADHD. Older teens and college students may be asked to complete this form before consultation appointments.