Patient Forms


All pertinent forms for patients of
Red Stick Pediatrics.

Form Overview


LHSAA


This is the form required by most athletic programs in order for an athlete to participate in athletic activities. Some schools/programs may have their own separate form. Please download and complete the appropriate sections before bringing it to your next appointment or dropping it off to be filled out. Remember that we can only fill this form out if the patient is up to date on their annual well child examinations.

LHSAA Form

New Patient PACKET


Please download and complete this packet to bring with you to your first visit with one of our physicians.

New Patient Packet


Medical Records Release


Please download and complete this form and drop it by our office if you wish us to request records from another physician.

Medical Records Release Form


NICHQ Teacher Assessment


This form is part of a child's comprehensive assessment for ADD/ADHD. This form should be downloaded and completed by at least one teacher from each of the child's educational environments. If the child has multiple teachers it is suggested that this form be shared with at least two teachers with which the child spends the largest part of their educational time. This form should be returned to our office before a visit to evaluate ADD/ADHD can be scheduled.

NICHQ Teacher Assessment Form


NICHQ Parent AssessmenT


This form is part of a child's comprehensive assessment for ADD/ADHD. This form should be downloaded and completed by at least one parent or guardian from each of the child's home environments. This form should be returned to our office before a visit to evaluate ADD/ADHD can be scheduled.

NICHQ Parent Assessment Form


NICHQ Teacher Follow Up


This form is used at every ADD/ADHD follow up visit to monitor a child's response to current treatment/medication. Please download and have at least one teacher complete this form to bring with you to your child's ADD/ADHD follow up visits.

NICHQ Teacher Follow up form


NICHQ Parent Follow Up


This form is used at every ADD/ADHD follow up visit to monitor a child's response to current treatment/medication. Please download and complete this form to bring with you to your child's ADD/ADHD follow up visits.

NICHQ Parent Follow up form

Contact

Red Stick Pediatrics