ATTENTION: JAVASCRIPT IS DISABLED.
Palm Beach Pediatric's website requires javascript to operate correctly.
Please enable javascript in your browser. Click on the link below for instructions to enable javascript on all browsers:
Click here to enable javascript
On this page 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.
In order to help speed up the process of checking in your child for his/her first visit with us, it will be helpful to print out the following forms at home and complete them prior to your visit with us.
For parents of newborns, please print out the following important information about pertussis, or whooping cough. If you are interested in getting vaccinated, let the front desk know when you check your infant in for his/her first exam in our office.
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 this form and bring it with you on the day of your appointment completed.
For all 11 - 17 year olds we are now screening for psychological issues. The Pediatric Symptom Checklist is the best way to do this screening. Please complete this form prior to your appointment and the provider will go over the results with you during your visit.
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. There is a form explaining the possible need for an EKG, a medical history form, and two questionnaires. These questionnaires need to be completed, one by your child's teacher(s), and the other by the parent(s). The more forms that are completed, the more accurate the assessment will be. Please remember to bring all of these forms with you for your visit.
For ALL ADD / ADHD appointments, a teacher and parent Follow-Up Questionnaire need to be completed and brought with you to the appointment. If you do not have these forms, we will not be able to give your child the best medical care and may need to re-schedule your appointment.
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.