Forms & Documents

Welcome to our Forms and Documents Page! Here you will find printable versions of forms you can fill out in advance of your visit.

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!

New Patient Forms
	New Patient Medical History Form (516KB)

	New Family Registration Form (441KB)


Practice Information
	MyChart Registration Process (31KB)

	MyChart Proxy Form (38KB)

	Registration & Consent for Electronic Communication (Email/Text Messaging) (478KB)

	Vaccine Policy Statement (32KB)

	Information on Vaccine Costs and Coverage (38KB)


ADD/ADHD Information
	Does My Child Have ADD/ADHD? (88KB)

	How We Evaluate Your Child for ADD/ADHD (89KB)

	For Parents of Children with ADD/ADHD (162KB)

	Tips for ADD/ADHD Related Sleep Problems (91KB)

	Educational Rights for Children with ADD/ADHD (682KB)

	Homework Tips for Parents of Children with ADD/ADHD (89KB)

	Working with Your Child's School (92KB)


ADD/ADHD Initial Evaluation Forms
	ADD/ADHD Initial Evaluation Form for Parent to Fill Out (1178KB)

	Vanderbilt ADD/ADHD Initial Evaluation Assessment Scale - PARENT TO FILL OUT (105KB)

	Vanderbilt ADD/ADHD Initial Evaluation Assessment Scale - TEACHER TO FILL OUT (189KB)

	ADD/ADHD Cardiac Risk Factors Forms - PARENT TO FILL OUT (750KB)


ADD/ADHD Follow Up Forms
	Vanderbilt ADD/ADHD Follow Up Assessment Scale - PARENT TO FILL OUT (189KB)

	Vanderbilt ADD/ADHD Follow Up Assessment Scale - TEACHER TO FILL OUT (516KB)


Flu Vaccine Forms
	No Flu Drive Thru Map (1227KB)

	Flu Mist Info: Live, Intranasal Influenza Vaccine 2012-2013, What You Need to Know (112KB)

	Flu Mist Consent Form 2012-2013 (274KB)

	Flu Shot Info: Inactivated Influenza Vaccine 2012-2013, What You Need to Know (292KB)

	Flu Shot Consent Form 2012-2013 (67KB)