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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)

Demographic Form

Financial Policy

History Form

Current Patient Forms

Release of Information (Transfer Into Practice)

Release of Information (Records Request)

Release of Information (Transfer Out of Practice)

Patient Centered Medical Home

Immunization Contract Form

Flu Questionnaire Form

Behavioral Forms

M-CHAT Checklist for Autism in Toddlers

PHQ-9 Questionnaire, modified for Teens (Depression)

GAD-7 Questionnaire (Anxiety)

SCARED Child Form (Anxiety)

SCARED Parent Form (Anxiety)

NICHQ Vanderbilt Assessment Scales (ADHD)

Adult ADHD Self-report Scale

Physical Forms

MHSAA Sports Physical Form

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

Patient Portal Forms

Patient Portal Sign-Up (14 and younger)

Patient Portal Sign-Up (15 and older)