All forms are in a PDF file format. You can download Adobe Acrobat Reader for free.
Registration Forms
- New Patient Packet – includes Clackamas office map
- New Patient Packet – includes Happy Valley office map
- New Patient Packet – includes Meridian Park office map
- New Patient Packet – includes NE Portland office map
- New Patient Packet – without maps
- Patient Registration Form
- Patient Health History Form
- HIPPA Acknowledgement and Consent
- HIPPA Notice of Privacy Practice Packet
Developmental Screening Forms
12 month Well Child Check
18 month Well Child Check
- Developmental Questionnaire ASQ-English
- Developmental Questionnaire ASQ-Spanish
- Autism Screening Questionnaire – MCHAT – English
- Autism Screening Questionnaire – MCHAT – Spanish
- Autism Screening Questionnaire – MCHAT – Vietnamese
24 month Well Child Check
- Developmental Questionnaire ASQ-English
- Developmental Questionnaire ASQ-Spanish
- Autism Screening Questionnaire – MCHAT – English
- Autism Screening Questionnaire – MCHAT – Spanish
- Autism Screening Questionnaire – MCHAT – Vietnamese
3 Year Well Child Check
4 Year Well Child Check
5 Year Well Child Check
ADD-ADHD forms
- ADD-ADHD Teacher Assessment – Vanderbilt
- ADD-ADHD Parent Assesssment – Vanderbilt
- ADD-ADHD Parent Questionnaire – Conners
- Behavior Assessment (Short form) – Teacher
General Forms
- Circumcision Post-Op Care PDF Parent Handout – Circumcision v10-10
- Authorization to Use or Disclose Protected Health Information
- Sports Pre-Exam Questionnaire
- Childhood Immunization Schedule Q & A
- AAP Vaccine Safety Facts
