Patient Forms
New Patients (please print, complete and bring to your child’s first appointment).
- Premier Pediatrics Patient Form – PDF
- Patient Communication Form – PDF
- Ages and Stages Questionnaire – Child development screening: Please complete no more than one week before your child’s appointment. Print out the completed copy and bring this to the scheduled appointment.
- Request A Copy of Your Medical Records (for yourself) – PDF
- Request Medical Records Release (to a third party) – PDF
Other Forms
- ADHD Questionnaire – NICHQ Vanderbilt Assessment Scales – PDF
- Depression Questionnaire – PHQ-9 – PDF
- Screen for Child Anxiety Related Disorders (SCARED) – For child to complete – PDF
- Screen for Child Anxiety Related Disorders (SCARED) – For parent to complete – PDF
- Autism Questionnaire – Modified Checklist for Autism in Toddlers, Revised, with Follow-up (M-CHAT-R/F) – PDF
- Postnatal Depression Questionnaire – Edinburgh Scale – PDF