Check-up Forms

Our office is now using Phreesia which is an electronic check in system that will allow your completed forms to import into your child’s chart at the time of completion. Most of our forms are in this electronic version and we are working to incorporate the remaining forms as soon as possible (some forms are copyrighted and we are not allowed to reproduce).

Please arrive 10-15 minutes early for your child’s appointment to allow time to complete the forms.

Listed below are what you can expect to complete at each visit.

All Ages 9 Months 12 Months / 1 Year
18 Months 24 Months / 2 Years 30 Months / 2 1/2 Years
3-11 Years 11-18 Years

All Ages

For each visit please remember to bring your child's insurance card.

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9 Months

You will be asked to complete the PEDS Response Form (Parents Evaluation of Developmental Status) in the exam room.

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12 Months / 1 Year

Family Medical History Form - Completed on the Phreesia pad

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18 Months
  • MCHAT - Completed on the Phreesia pad
  • You will be asked to complete the PEDS Response Form (Parents Evaluation of Developmental Status) in the exam room.

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24 Months / 2 Years
  • Family Medical History Form - Completed on the Phreesia pad
  • Strong4Life Healthy Habits Assestment - Completed on the Phreesia pad
  • MCHAT - Completed on the Phreesia pad
  • You will be asked to complete the PEDS Response Form (Parents Evaluation of Developmental Status) in the exam room.

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30 Months / 2 1/2 Years
  • Strong4Life Healthy Habits Assestment - Completed on the Phreesia pad
  • You will be asked to complete the PEDS Response Form (Parents Evaluation of Developmental Status) in the exam room.

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3 - 11 Years
  • Family Medical History Form - Completed on the Phreesia pad
  • Strong4Life Healthy Habits Assessment - Completed on the Phreesia pad

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11 - 18 Years
  • Family Medical History Form - Completed on the Phreesia pad
  • Adolescent Strong4Life Healthy Habits Assestment - Completed on the Phreesia pad
  • Pre-participation Physical Evaluation - Click to download (PDF) *we are awaiting approval to add this form electronically

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