Pediatrics Forms & Resources

New Patient Forms

Join Our Practice
Clark Pediatrics Patient Forms
Medical Record Release Authorization
Routine Immunizations
Routine Check-up Guide
Importance of a Medical Home
Clark Pediatrics Philosophy
2023-24 IHSAA Physical Form
Vaccine Policy Statement

ADHD Forms

NIHQ Vanderbilt Assessment Follow-up Parent Informant-D5
NIHQ Vanderbilt Assessment Follow-up Teacher Informant-D6
NICHQ Vanderbilt Assessment Scale - Parent Informant
NICHQ Vanderbilt Assessment Scale - Teacher Informant

Links

CDC Vaccine Information
Healthy Children
Vaccine Education Center
Symptom Checker
Telehealth

A patient may ask for an estimate of the amount the patient will be charged for a nonemergency medical service provided in our office. The law requires that the estimate be provided within five business days of scheduling the nonemergency health care service unless the nonemergency health care service is scheduled to be performed by the practitioner within five business days of the date of the patient’s request. The estimate is valid for 30 days. Patients who are Medicaid recipients are excluded.