Below you will find a complete list of our patient forms. In an effort to provide the best customer service possible, and minimize your wait time in our office, please review this list and bring in the necessary forms already completed.
We take the privacy and security of our patients information very seriously. Understanding that, we are unable to accept any form that contains protected health information (PHI) via email. This includes any form that contains 2 or more pieces of identifying information (name, address, date of birth, telephone number, etc.)
Please submit completed forms in-person, via Fax, or US Mail.
In order to speed up the process of checking in your child for his/her first visit with us, it will be helpful, and minimize your wait time, if you would print out the following forms at home, complete them as best you can, and bring them with you to your visit.
Additional New Patient Forms (Newborns)
ADD / ADHD
If your child has never been diagnosed with ADD or ADHD, please complete the following paperwork prior to your child’s first appointment for this evaluation. The more forms that are completed prior to your visit, the more accurate the assessment will be. Please remember to bring all of these forms with you to your visit.
ADD / ADHD / Behavioral Evaluation
ADD / ADHD / Behavioral Follow-Up
Well Visit (2 weeks - 6 months)
Maternal postpartum depression screening for mothers with children 2 weeks to 6 months of age. Please print and complete this form and bring it with you on the day of your appointment.
Well Visit (18 months & 2 years)
For 18 month and 2 year check-ups, the M-CHAT is a screening test for Autism that we perform at these two visits. Please print and complete this form and bring it with you on the day of your appointment.
Well Visit (4 years - 11 years)
We are screening for behavior issues with the Pediatrics Symptom Checklist for all children ages 4 years – 11 years of age. Please print and complete this form and bring it with you on the day of your appointment. This screening will be discussed with you by your provider. This form is to be filled out by the parent.
Well Visit (11 years and Beyond)
We are screening for depression with the PHQ-9 is all teens from ages 12 and up. Please print and complete this form and bring it with you on the day of your appointment. This screening will be discussed with you by your provider. This form is to be filled out by the child.
Our behavioral health integration program is aimed to streamline the care your child and family receive with the convenience of receiving services at a centrally located medical home that is comforting and familiar. Medical practices that have initiated an integrated practice receive feedback of greater satisfaction among patients and pediatricians as we are able to communicate seamlessly through existing records, referrals and follow-up. We are determined to meet the needs of our patients that have struggled to link their child’s services together.
The different counties served by Palm Beach Pediatrics each have their own specific form for school sports physicals. As these forms change annually, we have provided you a direct link to these respective forms. Please choose the county school district your child is enrolled in, print the form, and bring it with you to your appointment. Unfortunately, we are not aware of the Martin County school district having any sports physical forms online at this time.
Palm Beach County
On the Palm Beach County School District website, scroll down the page and select the level of schooling that applies to your child and choose the applicable forms.
St. Lucie County
On the St. Lucie County School District website, scroll down the page, almost to the bottom, and find the section in the center column entitled, ATHLETIC RESOURCES. Select the respective packet of forms dependent on the age of your child