Please see the forms below. If you are a new patient please print this out and fill it in at home to save yourself time on your first visit.

Notice of Privacy Policy

Financial Policy

Patient Registration form

Kentucky certificate of Immunization

Kentucky Athletic participation form

Medications needed at school

Authorization for release of medical records

Guardianship form

Headstart - 4th Grade Preventive Forms

5th - 12 Grade Preventive Forms

NICHQ Vanderbilt Assessment Scale—TEACHER Informant

NICHQ Vanderbilt Assessment Follow-up—TEACHER Informant

NICHQ Vanderbilt Assessment Scale—PARENT Informant

IQHealth

9 Month Lead Risk

18 Month Speech Eval and MCHAT

2 Year Speech Evaluation

2 and Half Year Speech Evaluation

3 Year Speech Evaluation and TB Risk

4 Year Speech Evaluation

Preteen 12 to 14 Yr

Teen Screen 15 to 19 Yr

Middle School Sports Forms

High School Sports Forms

Concussion Form Soccer, Football, Baseball, Lacrosse, Basketball, Softball, Wrestling

Anxiety Screen Parent Version 11 and Under

Anxiety Screen Child Version 11 and Under

Depression Screen 11 to 14

Depression Screen 15 to 19

ADHD Adult Form

Consent 18 and Over Form