Forms

Welcome to our Forms and Documents Page for your kids' medical visit! Here you will find printable versions of forms you can fill out in advance of your pediatric doctor visit. If your child has a Well Child Check coming up, check your MyChart account for an electronic version of the questions to answer and send back to us before your visit!

Twin City Pediatrics Forms Policy

(school physicals, sports forms, daycare forms, etc.)

- Forms brought on same day of appointment will be completed that day free of charge

- Forms brought without a corresponding appointment that day will be completed within 5-7 days at no additional charge

- Forms needed anytime less than 5 days will be expedited and completed for an additional charge of $15 per patient. 

For Parents of New Patients...

Welcome to Twin City Pediatrics! We invite you to print and fill out our New Patient Forms and bring them with you to your first visit!

ADHD - Initial Forms

• ADD/ADHD Initial Evaluation Questionnaire (39 KB)
• Parent Initial Vanderbilt form (516 KB)
• Teacher Initial Vanderbilt form (189 KB)
• ADHD Cardiac Risk Factors Questionnaire (39 KB)

ADHD - Follow Up Forms

• Parent Follow Up Vanderbilt Form (189 KB)
• Teacher Follow Up Vanderbilt Form (189 KB)

School/Parent Consent Forms

• Communication Consent Form-School to TCP (60 KB)
• Communication Consent Form-TCP to School (124 KB)

Behavior Forms

• SCARED-parent form (56 KB)
• SCARED-child form (58 KB)
• Behavior Questionnaire (22 KB)
• RCADS-child form (3-12th grade) (511 KB)
• RCADS-parent form (3-12th grade) (451 KB)
• MOAS - Modified Overt Aggression Scale - parent form (50 KB)
• Screen for Adult Anxiety Related Disorders (SCAARED) - College Age Patients (300 KB)

New Patient Forms

• New Patient Information (58 KB)

Nutrition

• New patient - Nutrition Form (247 KB)
• Nutrition new Pt - Spanish (248 KB)

ADHD parent letter

• ADHD parent letter (26 KB)