Patient Forms
The following forms will be helpful to you prior to your visit. Click text to open or save file.
Non-Discrimination Policy
New Patients
New Patient History Form
Vaccine Policy
Established Patients
School/Daycare/Camp
Guilford County Medication Authorization Form
Kindergarten Health Assessment 2016
NCHSAA Student-Athlete Preparticipation Physical Evaluation (PPE) (’20/’21)
Child Care Form
ADHD
Self-Report Rating Scale – Parent
Self-Report Rating Scale – 12 years and older
Self-Report Rating Scale – 18+
Vanderbilt Rating Scale – Teacher
Vanderbilt Rating Scale – Parent
ADHD Medication Prescription Policy
Healthy Habits Program
Nutritional and Activity Assessment
Activity Log
HIPAA
Consent to Discuss Health Information
CPT Financial Policy 2017
No Show and Cancellation Policy 2017
Vaccine Policy
Permission to Discuss PHI
Authorization to Release Medical Information