All Forms
Visit the Patient Portal to ...
- Review upcoming and past appoinments
- Pay your bill online
- Send a message to your provider
School Based Health Centers
Asthma Control Test ages 12 and older
Asthma Control Test ages 12 and older – Spanish
Bright Futures Physical age 5 – Spanish
Bright Futures Physical age 6 – Spanish
Bright Futures Physical ages 7-8
Bright Futures Physical age 7 – Spanish
Bright Futures Physical age 8 – Spanish
Bright Futures Physical ages 9-10
Bright Futures Physical ages 10 – Spanish
Bright Futures Physical ages 9 – Spanish
Bright Futures Physical ages 11-14
Bright Futures Physical ages 11-14 – Spanish
Bright Futures Physical ages 15-17
Bright Futures Physical ages 15-17 – Spanish
Bright Futures Physical 18+ – Spanish
Consent to Flu Vaccination – Spanish
Pediatric Symptom Checklist (PSC) – Parent
Pediatric Symptom Checklist (PSC) Parent – Spanish
Pediatric Symptom Checklist (PSC-Y) – Youth
School Based Mental Health Referral
Sports Physical Evaluation – Spanish
Consentimiento para la Administración de Vacunas
Prueba de control del asma de la infancia para niños/as de 4 a 11 años
Individual forms
Authorization for Release of Protected Health Information (PHI)
Child First Authorization to Use and Disclose Health Information
Child First Consent to Photography and Video
Circle of Security Parenting Group Permission to Participate
Client Outcome Measures – Adolescent
Client Outcome Measures – Parent
Client Rights and Responsibilities – Psychiatric Medication Management
Columbia Teen (11 years old +) – to be completed by teen
Columbia Teen (11 years old +) – to be completed by parent
Drug Authorization and Consent
IICAPS Authorization for Release of PHI
Psychiatric Developmental History
Reunification and Therapeutic Family Time Plan
Video and Audio Recording Release
Autorización para la divulgación de información de salud protegida
Client Rights and Responsibilities – Psychiatric Medication Management Spanish
Escala de Depresión de Columbia (11 años de edad y mayores) – A COMPLETAR POR EL/LA ADOLESCENTE
Escala de Depresión de Columbia (11 años de edad y mayores) – A COMPLETAR POR LOS PADREST
Historia del desarrollo psiquiátrico
Revisión del Cuestionario del Sistema
