When coming into the office, we want all our families to be familiar with our privacy and practice policies. These policies are evaluated annually as a way to protect all parties and as a way to understand how the office operates. We invite all of our families to look them over and if you have any questions or concerns feel free to call or email our office for the Compliance officer or Office manager.
Many of these forms below are to be completed annually while other's vary by age and appointment type. You may complete these forms ahead of your appointment and return them to the office via portal attachment, fax, or in-person per calendar year.
Office Visit Forms: Misc. Forms:
- Acknowledgement of Privacy Practices Form Food Allergy Action Plan
- ASQ (9mo) Kentucky Immunization Certificate Form
- ASQ (18mo) Ohio Dept. of Job and Family Services (Daycare form)
- ASQ (24mo) 2023-24 Ohio Athletic Sports Physical Form (OHSAA)
- ASQ (30mo) Vanderbilt Parent
- CRAFT (teenagers) Vanderbilt Parent Follow up
- Edinburgh (post-partum) Vanderbilt Teacher
- Family Medical History (needed for 1st visit) Vanderbilt Teacher Follow up
- GAD-7 Work Permit
- Medical Consent Authorization
- Medical Record Release Authorization
- Notice of Privacy Practices
- Patient Registration Form
- Patients Rights and Responsibilities
- PHQ-2 (teenagers)
- PHQ-9 (teenagers)
- Preventive + Sick Visit (annually)
- SCARED (Parent and Child forms)
- Telehealth Consent Form
- Teenage Consent (age 16+)
In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.