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Forms

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Please print and complete the appropriate form(s) before your appointment.

New Patient Information
Update Patient Information
Kids Count Pediatrics Self-Pay Policy
Peds Response Form (6 mon and yearly check ups)
M-CHAT Form (18 mon and 2 year checkup)  (forma española)
Lead Risk Assessment Questionnaire
PPD Screening (1, 2 and 5 year check up)
Sports Physical Form
Child History Questionnaire (for mental health patients)
ADHD Assessment Form (for parents)
ADHD Assessment Forms (for teachers)