Patient Forms

To save you valuable time, we encourage you to download and complete these forms ahead of your visit.
For your convenience, and to save a tree, both Pediatric and Adult New Patient Packets are available here for download and completion prior to your first appointment. The new patient paperwork is different from the questions asked when registering the portal. If you choose to go this route and be ahead of the game on your first visit, please upload the completed forms to your patient portal prior to your appointment. In order to upload the forms, you will have to complete the registration for the portal that was sent to your email.

Here is how you will upload your new patient packet:

When you are in the portal, you will see “Have a question for your provider?” Here you will select your provider from the drop-down feature. For the subject line, you will select “Other”. Your message can say, “new patient paperwork”. Attach your file of paperwork and hit send a message. This will then upload the packet to your chart so your provider has time to review it before your first appointment.

Completing these forms in full allows our providers to best support you in achieving the most optimal healthcare.

If you’d prefer to complete your forms in person, please arrive at our clinic 30 minutes before your scheduled appointment time.

​Thank you for helping us provide you with the best care possible. We look forward to seeing you for your integrative primary care visit!

New Patient Forms

Adult New Patient Packet
Download
Pediatric New Patient Packet
Download

Adult Mental Health

PHQ-9 and GAD-7 Form_a
Download
Substance Use Screening – CRAFFT
Download

Child Behavioral Health

Pediatric Symptoms Checklist
Download
SCARED Anxiety Screening – Child Version
Download
SCARED Anxiety Screening – Parent Version
Download
Substance Use Screening
Download
Vanderbilt Parent Assessment
Download
Vanderbilt Teacher Assessment
Download

Autism Evaluations

18+ years – Autism Spectrum Quotient
Download
4-11 years – Childhood Autism Spectrum Test
Download
7-16 years – Autism Spectrum Screening Questionnaire
Download
SCARED Anxiety Screening – Child Version
Download
SCARED Anxiety Screening – Parent Version
Download
Vanderbilt Parent Assessment
Download
Vanderbilt Teacher Assessment
Download

Well-child Visits

1-2 months
Download
11-12 months
Download
13-14 months
Download
15-16 months
Download
17-18 months
Download
19-20 months
Download
21-22 months
Download
23-25 months
Download
25-28 months
Download
28-31 months
Download
3-4 months
Download
31-34 months
Download
34-38 months
Download
39-44 months
Download
45-50 months
Download
5-6 months
Download
51-56 months
Download
57-65 months
Download
7-8 months
Download
9-10 months
Download