Completing necessary paperwork prior to your child’s visit helps quicken the check-in process. Please take a minute to complete all applicable areas on the form prior to returning it to our office.

New Patient Registration – Primary Pediatrics
New Patient Registration – Acute Care Visit Only
New Patient Registration – Cardiology Patients
Medical Record Release (Waldorf, MD)
Medical Record Release (Hollywood, MD)
Welcome Letter
Covid Testing Consent Form (For non-PM Kidz patients)

HIPPA Privacy Policy
Financial Policy

Maryland Health Inventory – School Physical
Sports Physical
Medication Administration Authorization
Immunization Certificate
Blood Lead Testing Certificate
Diet Modification Form for Special Dietary Needs

6 months
9 months
12 months
15 months
18 months
24 months
30 months
36 months

M-CHATR/F (18 months and 24 months)

Pediatric Symptom Checklist (ages 4-10)
Pediatric Symptom Checklist - Youth (ages 11 years and older)

Vanderbilt Parent Initial
Vanderbilt Teacher Initial

Vanderbilt Parent Follow-up
Vanderbilt Teacher Follow-up

SCARED (ages 11 years and older)
SCARED (parent)

PHQ for Teens
Edinburgh Postnatal Depression Scale (for moms with infants from birth to 12 months)
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