Patient Forms and Documents - Pediatric Wizards
Easy Access to the Forms You Need—All in One Place
Save time during your visit by completing your patient forms and documents in advance. Whether you’re a new patient or need documentation for school, insurance, or medication management, we’ve made it simple to download, fill out, and submit.
Need help choosing the right form?
Important Reminders About Patient Forms and Documents
- Bring completed forms to your appointment or fill them up online through our HIPAA compliant Patient Portal. Forms not completed at the time of your visit may be subject to a $25 fee.
- Allow up to 30 business days for medical record requests. Printed medical records not sent directly to another provider are subject to a fee of $25 for the first 25 pages, plus $0.25 per page thereafter.
- A $1 per page fee may apply for extra copies of records or forms not picked up within 30 days.
- Ensure all forms are signed and dated to avoid delays in care or processing.
New Patient Form
These patient forms and documents are required for your child’s first visit to Pediatric Wizards. Please complete them in advance to help us get to know your child and provide timely care.
IMPORTANT:
- Be sure to also print and complete the Patient Information Form found under the Patient Information tab.
- If you’re transferring from another practice, please download and fill out the Medical Records Release Form and send it to your previous provider. This allows us to receive your child’s records before your first appointment.
[Download New Patient Form]
[Download Medical Records Release Form]
Checkup and Consent Forms
[Download M-Chat] - Please fill out these patient forms and documents prior to your child’s 18 month & 2 year well visit in our office.
[Download 30 Month Questionnaire] – A developmental screening tool for parents of 30-month-olds to assess key milestones in communication, motor skills, and social development.
[Download Newborn Feeding Questionnaire*] - A questionnaire used to determine if you are experiencing feeding issues with a newborn or infant. Please fill this 24 hours prior to your 1 week follow-up visit in our office.
[Download Medical Records Release Form] - To request a copy of your child(ren)’s medical record, please fill out the following form and fax/mail to our office. Medical Records may take up to 14 business days to process once the signed request is received in our office.
[Download Designee Authorization Form] - Authorizes a trusted adult other than the parent or guardian to bring your child to appointments and make care decisions during the visit.
[Download Medical Consent Form] - If someone else needs to bring in your child for a visit, please have this form filled out and with them.
[Download New Patient Vaccination Policy*] - Acknowledges agreement to follow Pediatric Wizards’ vaccination policy based on CDC guidelines as a condition for establishing care.
Mental Health & Behavioral Screening Forms
[Download Anxiety Screening Form] - Helps assess anxiety symptoms in children and teens.
[Download PHQ Anxiety and Depression Form] - These patient forms and documents are used during wellness or chronic care visits to screen for signs of depression.
[Download ADHD Vanderbilt Parent Form] - Evaluation form for parents to complete as part of the ADHD assessment process.
[Download CRAFFT Drug & Alcohol Form] - A confidential screening tool used with adolescents to assess risk related to substance use, including drugs and alcohol.
[Download HIPAA Form*] - Notice of Privacy Practices. This is for your records only. You do NOT need to print this for our office.
Submit Forms Securely
Use our HIPAA-compliant Patient Portal to upload completed patient forms and documents, view visit summaries, or request additional documentation.
Have Questions About a Form?
We’re here to help you complete and submit your child’s paperwork accurately and on time. Contact our friendly staff at Pediatric Wizards if you’re unsure which form to use or how to fill it out.
