Pediatrics: Forms

At specific well visits throughout your childs development we will ask you to complete forms that will help guide us in their care

  • Vanderbilt forms are scoring sheets that we use to decide if a child may have attention deficit disorder or other behavioral health concerns. The forms are only one part of the puzzle that includes a good history and exam in your child's home office. There are forms for parents as well as teachers. There are "initial" forms for first time assessment and "follow-up" forms for children who have already been diagnosed with behavioral concerns.
  • The MCHAT is a screening questionnaire that we use to decide if a young child should have further testing for autism. Like all screening tools, there are many kids that might show some concerning signs at first glance, that later prove to be normal. We usually have the parent or guardian complete the MCHAT at the 18 month and 2 year check ups.
  • PHQ-9 and PSC forms are used in our office to screen for any behavioral health concerns.

Camp, school and sports forms

There will be times when you need us to complete forms so your child may attend school, play a sport,  or go to camp. Please be sure to contact the office as soon as you know a form is needed so we may determine if an office visit is required. When dropping off a form (or bringing it to an office visit)  please be sure to fill out all of the "parent" portion ahead of time.  Forms can usually be completed within 1 - 2 weeks.  When you drop off your form let us know if  you will be picking them up or if you would like them mailed

 

Other RiverBend forms you may need

Caregiver Authorization Affidavit

Massachusetts Temporary Agent Authorization Form

Vanderbilt form-teacher

Vanderbilt form-parent

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