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To get started, please download your forms

At Trestlewood Pediatrics, we understand that your time is valuable, and your child's care is of the utmost importance. This is why we ask that you have these forms completed before your visit. If you run into any issues or have a question that you don't know how to answer, please don't hesitate to contact our offices. To begin, please click on the form you need, print, fill out, and return the form(s) to our office. The forms included below are best viewed using Adobe Reader.

Background Patient Forms

Privacy Act (HIPAA)

Download

Demographic Form

Download

Financial Policy

Download

History Form

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Current Patient Forms

Records Release to Transfer Out

Download

Patient Centered Medical Home

Download

Immunization Contract Form

Download

Flu Questionnaire Form

Download

Behavioral Forms

M-CHAT Checklist for Autism in Toddlers

Download

PHQ-9 Questionnaire, modified for Teens (Depression)

Download

GAD-7 Questionnaire (Anxiety)

Download

SCARED Child Form (Anxiety)

Download

SCARED Parent Form (Anxiety)

Download

NICHQ Vanderbilt Assessment Scales (ADHD)

Download

Adult ADHD Self-report Scale

Download

Physical Forms

MHSAA Sports Physical Form

Download

Health Appraisal Form (NOTE: Parents complete "Personal" and "Section 1")

Download

Patient Portal Forms

Patient Portal Sign-Up (14 and younger)

Download

Patient Portal Sign-Up (15 and older)

Download