All New and Existing Patients are required to complete a Registration Packet before their first/first annual visit. The Patient Registration Packet is located under the Patient Registration/Annual Forms tab below.
Visit our Behavioral Health or Endocrinology pages for more information and specific forms.
- Patient Registration/Annual Forms
- Patient Pre-Visit Screening Forms
- School & Daycare Forms
- Online Requests
Patient Registration Forms Packet
(a separate patient registration packet must be completed for each child)
Our Spanish patient registration forms are in the process of being completed and will be updated here in the coming weeks. Please let our staff know when checking in if you need Spanish forms to complete at your visit.
If you would like to designate a “proxy” (someone other than the parent) for medical visits or consent, please complete the additional online form below:
Proxy Consent Form (if designating a proxy)
Complete the online pre-visit forms below based on your child’s age, prior to your upcoming well visit.
*If your child’s age is not listed, no pre-visit forms are needed!
- 1 month – Edinburgh
- 2 months – Edinburgh
- 4 months – Edinburgh
- 6 months – Edinburgh
- 9 months – ASQ
- 18 months – ASQ and MCHAT
- 24 months – MCHAT
- 30 months – ASQ
- 36 months – ASQ
- 12 – 21 years – PHQ-9
Complete the online pre-visit forms below for each specific visit type, prior to your visit.
- ADHD/ADD Consult or Medcheck –Vanderbilt Parent Form, Vanderbilt Teacher Form
- Anxiety Consult – SCARED (parent), SCARED (child, 8 and above), GAD-7
- Depression Consult – PHQ-9
Please check with your school and daycare directly to access the required forms needed and deadlines for submission.
You can bring your forms with you to your scheduled visit to be completed or submit them ahead of time using our “Request for Forms Completion” online link below.
To request a form to be completed, click HERE.
When submitting forms, always remember:
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Please pre-fill out the parents portion of each form BEFORE submitting for completion. Without the parent portion pre-completed, we will need to send the form back and the process will take longer.
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Please submit the actual form document. Screenshots and pictures of forms are not acceptable options.
Appointment Request
• This request form is for future appointments only. Same day appointments must be made by calling 410-263-6363, Option 1.
• If requesting an appointment for a new patient, please call our appointment line directly at 410-263-6363, Option 1.
• Please note that Online Appointment requests may take up to 5 business days to process.
• For a list of local, downloadable school and daycare forms, visit our “School & Daycare Forms” tab above.
Request for Asthma Action Plan Form Completion
Request for Food Allergy Action Plan Form Completion
NOW AVAILABLE THROUGH YOUR PATIENT PORTAL:
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Refill Requests
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Referral Requests
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Immunization Records
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General Information messaging
Need to sign up for the portal? Click HERE.
Having trouble accessing your patient portal? Email [email protected]